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 A 30 year old male patient resident of Gudipally came to the casualty on 23/11/22 of altered

behaviour since yesterday Involuntary micturition since yesterdayGiddiness since

morningHOPI.Patient was apparently asymptomatic till 12 am last night then he started behaving

abnormally which was sudden in onset in terms of not .responding when spoken to,irrelevant talk

which is repetitive and self talking.patient is irritable every few minutes and abuses family members at

times.Patient had history of alcohol consumption since 10 years currently 6 to 10 units daily

throughout day,reports craving for alcohol, sweating and trembling when he doesn't consume

alcohol.patient stopped consumption for the past 10 days till yesterday but was given 3 units I/v/o

tremors@ 10:30 am which subsided after consumption . patient.also reported double images and

slurring of speech and memory disturbances since 10 days.patient reports consumption of tobacco in

the form of smoking(10 cigarettes per day).

PAST HISTORYH/O fall 1 month back ,sustained injury @

head.N/K/C/O DM,HTN, TB ASTHAMA, EPILEPSY

.FAMILY HISTORY: not significant

PERSONAL

HISTORYDIET: MixedAPPETITE: decreasedSLEEP: disturbedBOWEL AND BLADDER

MOVEMENTS: regularADDICTIONS: alcoholic since 10 years.ON EXAMINATION.Patient is

conscious.No signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy,edema.TemperatureBP:

120/80 mm hgPR:68/minRR:18/ minSPO2:98% at room air.GRBS: 98MG/DL.SYATEMIC

EXAMINATIONCNS.HMF: orientation to place and person present and to time absent.PUPILS:

NSRLSPEECH: normal.CRANIAL NERVE EXAMINATION: INTACTSENSORY SYSTEM

NORMALMOTOR SYSTEM RIGHT. .LEFTTONE. UL Normal normal LL. Normal. normalPOWER.

UL. 4/5. 4/5 LL. 4/5. 4/5.REFLEXES. RIGHT. LEFTBICEPS. 2+. 2+TRICEPS. 2+. 2+SUPINATOR.

2+. 2+KNEE. 2+. 2+ANKLE. 2+. 2+PLANTAR. 2 +. 2+SENSORY SYSTEM: normal.CEREBELLAR

SIGNSFINGER NOSE TEST - IN COORDINATION PRESENTFINGER FINGER TEST- IN COORDINATION PRESENTROMBERGS -

NEGATIVEDYSDIADOKINESIA- NEGATIVEGAIT - NORMALCVS examination:S1, S2 are heard.No

murmurs.Respiratory system examination:Inspection: Chest is moving bilaterally symmetrical. No

pulsations.Palpation: Trachea is central in postion.Percussion: ResonantAuscultation: Breath sounds

are vescicular.Abdomen examination:Inspection: Shape is scaphoid. Movements are equal.Palpation:

No tenderness Normal temperature No organomegaly.Percussion: Normal.Auscultation: Bowel

sounds heard.COURSE IN THE HOSPITAL:30 YEAR OLD MALE WITH ABOVE MENTIONED

COMPLAINTS GOT ADMITTED AND NECESSARY INVESTIGATIONS WERE SEND AFTER

INITIAL ASSESSMENT.ON EXAMINATIONHMF: orientation to place and person present and to time

absent.PUPILS: NSRLSPEECH: normal.CRANIAL NERVE EXAMINATION: INTACTSENSORY

SYSTEM NORMALMOTOR SYSTEM RIGHT. .LEFTTONE. UL Normal normal LL. Normal.

normalPOWER. UL. 4/5. 4/5 LL. 4/5. 4/5.REFLEXES. RIGHT. LEFTBICEPS. 2+. 2+TRICEPS. 2+.

2+SUPINATOR. 2+. 2+KNEE. 2+. 2+ANKLE. 2+. 2+PLANTAR. 2 +. 2+SENSORY SYSTEM:

normal.CEREBELLAR SIGNSFINGER NOSE TEST - IN COORDINATION PRESENTFINGER

FINGER TEST- IN COORDINATION PRESENTROMBERGS - NEGATIVEDYSDIADOKINESIANEGATIVEGAIT - NORMALPSYCHAITRY OPINION WAS TAKEN IN VIEW OF ABOVE

MENTIONED COMPLAINTS AND WAS STARTED ON TAB LORAZEPAM FOR 5 DAYS,TAB

OLANZAPINE 2.5 MG FROM DAY 2,TAB LIBRIUM 10 MG AND 25 MG FROM DAY 3.ENT

REFERRAL WAS TAKEN IN VIEW OF THROAT PAIN AND WAS DIAGNOSED AS GERD AND

WAS PUT ON SYMPTOMATIC TREATMENTOPTHALMOLOGY OPINION WAS TAKEN IN VIEW

OF BLURRED VISION AND ADVISED FOR SPECTACLE USAGE.PATIENT CONDITION HAS

BEEN GRADUALLY IMPROVED AND HENCE BEING DISCHARGED IN HEMODYNAMICALLY

STABLE CONDITION.

Investigation

MRI BRAIN PLAIN: SUBTLE FLAIR HYPER INTENSE SIGNAL SEEN IN POSTERIOR

PERIVENTRICULAR WHITE MATTER

USG ABDOMEN: GRADE 1 FATTY LIVER

NO ORGANO MEGALY

NO FEATURES SUGGESTIVE OF SEROSITIS

Diagnosis ?ALCOHOL WITHDRAWL DELIRIUM ?ALCOHOL WITHDRAWL PSYCHOSIS ALCOHOL DEPENDENCE SYNDROME TOBACCO DEPENDENCE SYNDROME

Treatment Given(Enter only Generic Name)

1.IVF( NS,RL @ 75 ML/ HR2. INJ THIAMINE 200 MG IV/ TID3. INJ PAN 40 MG IV /OD/ BBF4.TAB

LORAZEPAM 2 MG PO/BD[23/11/22-26/11/22]5. INJ LORAZ 2 MG/ IM/ SOS6.TAB OLANZAPINE

2.5 MG MD[25/11/22-29/11/22]7.TAB LIBRIUM 10 MG PO/TID[26/11/22-29/11/22]8.TAB LIBRIUM 25

MG PO/HS[26/11/22-29/11/22]

Advice at Discharge

1.T.LIBRIUM 10 MG

1.....1.....2 - 2 DAYS 1....X....2- 2 DAYS

X......X.....2- 2 DAYS

X........X......1 - 5 DAYS

2.TAB OLANZAPINE 2.5 MG

1........X.......1 [15 TABLETS FOR 1 WEEK]

3.TAB MEMANTINE 5 MG

1.......X.......X[10 TABLETS FOR 1 WEEK]

4.NICOTEX GUMS 2 MG

1........1........X- 7 DAYS

5. TAB BENFOMET PLUS PO/OD - 2 WEEKS

6.2% BETADINE THROAT GARGLES DILUTED IN A GLASS OF WATER 3-4 TIMES/DAY- 1 WEEK

7.TAB PANTOP -D PO/OD [30 MINS BEFORE BREAKFAST ]- 1 WEEK

8.SPECTACLE USAGE DAILY

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