28 Y/O WITH SEIZURES

A 28 year old male, R/O Bommakallu, came with the chief complaints of seizures since 1 day.

The patient was apparently asymptomatic in April when he realised that he had lost about 10 kgs in a span of a week. Due to this, he consulted a doctor. On investigations, the doctor informed him that his kidneys were failing and that he would need dialysis.

The next day, the patient went to a second doctor for a second opinion, who confirmed the same diagnosis and suggested dialysis. He was also diagnosed with hypertension, for which he has been on antihypertensive medication regularly.

The following day, the patient came to our hospital to start dialysis. However, on doing an RTPCR, he was found to be COVID positive (asymptomatic). Hence, he was asked to isolate at home for 15 days.

Following isolation, after a month, he decided to start his dialysis treatment. Between the 24th of June and 19th of October, he had 27 rounds of dialysis. Additionally, he had four blood transfusions for his anemia. After this, he was told that his creatinine levels would be the same even if he continued dialysis, and hence the patient decided to stop the dialysis for the time being.

3 days ago, he developed fever- which was sudden in onset, high grade, associated with chills and rigors, and was associated with one episode of vomiting. He also had episodes of hematuria, with no frothy urine. No h/o loose stools or decreased urine output.

1 day ago the patient developed seizures. He had 3 episodes- one at 3am, then 7am, then 11am. Episodes were associated with uprolling of eyeballs, frothing at the mouth and postictal confusion for 15-20 minutes. There was no h/o tongue bite, involuntary micturition or defecation.

Since the seizure episode, his urine output decreased.

Personal History

Diet: Mixed

Appetite: Normal

Sleep: adequate

Bowel: regular

Bladder: decreased urine output

Family History

Insignificant

General examination

The patient is conscious, coherent, co-operative; well oriented to time, person, place.

Moderately built, well nourished.

Pallor present, pitting type bilateral pedal edema present.

Vitals

HR:

BP:

RR:

TEMP: afebrile

SYSTEMIC EXAMINATION

RS: BAE+, NVBS

CVS: S1, S2 heard; no murmurs

P/A: soft, non tender

CNS: NAD

EVALUATION

TREATMENT PLAN

-INJ PIPTAZ 2.25GM/IV/TID

-INJ LASIX 40MG/IV/BD

-INJ TRAMADOL 1AMP IN 100ML NS/IV/OD

-INJ NEOMOL 1AMP IN 100ML NS/IV/OD

-INJ THIAMINE 1AMP IN 100ML NS/IV/OD

-TAB ULTRACET 1/2 TAB QID

-TAB NODOSIS 500MG PO/BD

-TAB OROFER XT OD

-TAB SHELCAL CT OD

-TAB MONTEC-LC PO/BD

-SYP ASCORIL D 10ML/PO/TID

Comments

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