40 year old female with generalised weakness

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CBBLE UDHC SIMILAR CASES 


"This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box"

Patient came with chief complaints of generalised weakness since 10 days, pain in the right hypochondrium and constipation since 10 days, walking with support since 3 days.

HOPI:
Patient was apparently alright 15 years back then she developed pain in small joints of upper limbs which was gradually progressive and associated with morning stiffness for which she went to hospital and was tested for RA factor positive.

6 years back she developed generalised weakness which was insidious in onset and gradually progressed for which, when she visited hospital she was found to have low potassium levels for which she was advised oral potassium and her condition got improved.
Similar episode of generalised weakness was seen again 3 years back and was again improved by correction of potassium.
6 months back again she developed generalised weakness which was worsened and her speech was lost, she was unable to walk and unconscious, her saturation also dropped, in view of that she was intubated and put on mechanical ventilation for about 7 days along with potassium correction was done. After that she was able to do her work and was apparently alright.
Since 10 days she again developed generalised weakness.

Past history:
H/O blood transfusion 9 months back I/V/O anemia. 
N/K/C/O DM, HTN, CAD, ASTHMA.

Family history:
No significant family history

GENERAL EXAMINATION: 
O/E : Patient is C/C/C
Clubbing - absent
Pallor - absent
Icterus  absent
Cyanosis - absent
Edema of feet - absent
Lymphadenopathy  - absent

VITALS :
TEMPERATURE - 98.6
PULSE RATE - 80 BPM
BLOOD PRESSURE - 90/60 MM OF HG 
RESPIRATORY RATE - 20
SPO2 - 98 % AT ROOM AIR

SYSTEMIC EXAMINATION : 
CARDIOVASCULAR SYSTEM : S1 and S2 heard, no murmurs heard 

RESPIRATORY SYSTEM : BAE present, NVBS heard.

P/A : soft, non tender 

CNS: NAD

Investigations:

Hemogram:
Hb- 10.6
Total counts- 10,100
Plt- 2.20 

CUE:
Pus cells- 2-4
RBC- nil
EC- 2-3

RBS- 90


LFT:
TB- 0.86
DB- 0.20
AST- 16
ALT- 18
AP- 588*
TP- 7.7

21/6/22
RFT:
Urea- 28
Creatinine- 1.0
Uric acid- 2.2*
Calcium- 9.4
Phosphorus- 2.6
Sodium- 135*
Potassium- 2.8
Chloride- 104

23/6/55
Potassium- 3.5

ECG

USG

2D ECHO

Diagnosis:
Hypokalemia periodic paralysis. 

Treatment:

1. INJ. OPTINEURON 1AMP IN 100ml NS IV/OD
2. SYP. POTCHLOR 15ml /TID/WITH GLASS OF WATER
3. TENDER COCONUT WATER AND BANANA
4. INJ. KCL 2 AMPULES In 500ml NS over 5hrs /IV/STAT








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