27 year old Female with SEIZURES

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Name : K. Supriya (9th semester)

Roll number : 53 

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

27 year old female patient from Nakrekal came to the OPD with the ,

Chief complaints :

1 episode of Generalised tonic clonic seizures 

HOPI: 

Patient was apparently assymptomatic 12years ago ,then she underwent RTA followed by seizures ,for that she used medication .

8years ago ,She was diagnosed with thyroiditis associated with goitre for which she used carbimazole .

In 2015 - she underwent thyroid surgery ,where one lobe of thyroid is removed and continued on carbimazole 

In 2021 -her 2nd lobe of thyroid removed along with parathyroid gland and started on thyronorm 100mcg -she is not on follow up since then .

After thyroidectomy Surgery in 2021 ,patient complaints of parasthesias in B/l  lower limbs frequently ,for which she received multiple calcium injections but not relieved of parasthesias .

Now ,since 2 to 3 days she developed parasthesias , giddiness ,generalised weakness for which ,she was taken to local hospital in Nakrekal yesterday (i.e..,31st March at evening 5pm ) .

There ,Patient was started on Tramadol ,Neurobion and NS . 

With in No time ,she developed clinching of fists ,frothing and tongue bite (ie..,1 episode of seizure ) followed by 10-15 mints of postictal confusion . Then she was given inj midaz  2CC and inj levipil 1gm IV stat and was referred to our hospital .

She also complaints of excessive thirst .

No H/O fever, altered sensorium ,head ache ,vomitings ,neck pain ,chest pain .

Past History : 

not a known case of diabetes ,HTN ,Asthma ,epilepsy ,TB 

Personal History : 

Appetite : Normal 

Diet : Mixed 

Bowel and bladder movements : regular 

Sleep -adequate 

No addictions and allergies

General Examination : 

Patient is conscious ,coherent ,cooperative 

She is moderately built and moderately nourished 

No pallor , icterus ,cyanosis ,clubbing ,lymphadenopathy , edema 

Trousseaus sign :

Chvosteks sign :

Vitals : 

Temp : 98F

Pulse rate : 77bpm

Respiratory rate : 19cpm

Blood pressure: 120/80 mm hg 

Systemic Examination : 

CNS : 

Higher mental functions -intact 

Tone -normal 

Muscle power -5/5 

Reflexes - brisk 

Cerebellar signs: 

Finger nose test - normal 

Dysdiadokinesia -normal 

Sensory system - normal 

Gait :

CVS :

S1 ,S2 heard 

No murmurs 

RS:

Normal vescicular breath sounds heard

No crepitations .

PA: 

NAD

 Investigations : 

Provisional diagnosis : 

SEIZURES due to HYPOCALCEMIA ( POST - PARATHYROIDECTOMY) .

Treatment :