NEUROLOGY(A)

 

A1.

Evolution of the symptomatology:   apparently asymptomatic 9 days ago

                                                            

⬇

             

                                   suddenly started talking, as well as laughing to himself

              He was conscious, but oriented to time, person and place only from time to time

             He was unable to lift himself off the bed and move around, and had to be assisted

                                   associated with a decrease in food intake since 9 days

                                                                        ↓

 

              he was taken to a local RMP, given IV fluids, and referred to a higher care hospital

                 stopped drinking the same day, citing general body pains the day before

also had short term memory loss since 9 days, where he could not recognize family members from time to time

↘                                                                                                                              he had 2-3 episodes of seizures

                                                        ↙

 

                                        1 year ago                                           4 months ago

·        following cessation of alcohol for 24 hours

·        associated with restlessness, sweating, and tremors

·        Following this episode, he started drinking again

 

Anatomical localization: Central nervous system

Primary etiology: Chronic alcoholism

A2. Ans: I) Thiamine helps the body cells change carbohydrates into energy. It has been used 

 

as a supplement to cope with thiamine deficiency

 

ii)Lorazepam binds to benzodiazepine receptors on the postsynaptic GABA-A ligand-gated chloride channel neuron at several sites within the central nervous system.it enhances the inhibitory effects of GABA, which increases the conductance of chloride ions into the cell

 

iii)pregabalin subtly reduces the synaptic release of several neurotransmitters, apparently by binding to alpha2-delta subunits, and possibly accounting for its actions invivo to reduce neuronal excitability and seizures.

 

iv)Lactulose is used in preventing and treating clinical portal-systemic encephalopathy .its chief mechanism of action is by decreasing the intestinal production and absorption of ammonia.

 

v)Potchlor liquid is used to treat low levels of potassium in the body.

A3. Due to excess thiamine deficiency and excess toxins accumulation due to renal disease caused by excess alcohol addiction.

 A4. Since the patient is a known case of alcoholic there is a high chance of thiamine deficiency causing dry beri beri symptoms like korsakoff’s pyschosis and wernicke’s encephalopathy.

And also patient symptoms like disorientation to time, place and person also suggest their might be thiamine deficiency causing those symptoms.

A5. Patient had leukocytosis associated with fever, tachycardia and hypotension and also high urea:creatinine ratio showing prerenal kidney injury.

The injury could be due to decreased intake of food and water probable dehydration(hypovolemia), alcoholism, associated infection, acute hyperglycemia(?)

A6. Infection(?)[there is leucocytosis, fever and hypotension]

A7.                                      Alcohol

                                           ↓

                                       Delays wound healing

                                    Increased risk for infections


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