A CASE OF MULTIPLE JOINT PAINS UNDER EVALUATION ASSOCIATED WITH POTASSIUM IMBALANCE
A 31 years old female,who is a house wife ,came from janagon district with complaints of
Cheif complaints :
Deformity of bilateral knuckles
Loss of sensation in upper limb and lower limb with neck five days back
Came for management
HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic 1 year ago,and then she developed pain in right hand follow by ulnar deviation of fingers at second metacarpalophalengeal joint and progressed to 3rd,4th and 5th metacarpalophalengeal joint in a period of 1 month.
She developed pain in the joints :
bilateral wrists
bilateral elbow
Bilateral shoulder joints
Bilateral ankles
Bilateral knees
No pain in toes
She also developed swelling of her bilateral soles because of which she was unable to walks
She went to a rmp for which she was given some medicine and used during which pain decreased later on when she stopped those medication she again developed pains all over the joint
She used on and off when ever she had pain and stopped when she didn't and again went to a hospital 10 days back where she again got medication
The 2nd day night after using medication at about 2 am (the next day ) she felt loss of sensation at right hand followed by left limb the neck
She could not lift her head
she did not have shortness of breath during this episode
When taken to a nearby hospital where she was medication and she regained her sensation in first neck then limbs then hand
At the hospital on admission she had hypokalemia and after two days of treatment had hyperkalemia
she was referred to higher centre for management came here for management
No deformity in wrist joint ,thumb
Past History:
No similar complaints in the past.
Not a known case of
Diabetes
Hypertensive
Tb
Epilepsy
Asthama
PERSONAL HISTORY:
Diet mixed
Apetite decreased
Bowel once 2-3 days since a year
Earlier once a day
bladder moments regular
Sleep adequate.
Addiction: occasional toddy consumer
MENSTRUAL HISTORY:
Married for 15 years
Menarche at 15
Cycles were regular,3/30 days.
Pain 1 day before and 1 day during the cycle
1 pad/day
No Clots
No significant
GENERAL EXAMINATION:
Patient is conscious coherent cooperative and oriented to time place person
Patient is lean bulit and nourished.
No pallor
Noicterus
No cyanosis
No clubbing
No edema.
VITALS:
Afebrile
Bp:110/70mmHg
PR:84bpm
Systemic examination
CARDIOVASCULAR SYSTEM:
Apex beat felt at 5th intercostal space
Heart sounds normal
No thrills and murmurs
RESPIRATORY SYSTEM:
Chest symmetrical
Normal vesicular breath sounds
No crepts,rhonchi,rales
ABDOMEN:
Soft and non tender
No organomegaly
No visible scars and sinuses
HIGHER MENTAL FUNCTIONS:
The patient is conscious coherent and cooperativer And oiented to time place and person
Cranial nerve
No abnormalities detected
MOTOR SYSTEM:
No muscle wasting is observed.
Tone of all muscle normal
Power of all muscle 5/5
No involuntary movements or tremors are seen
SENSORY SYSTEM:
All sensation retained
No abnormal sensations are present
Joint examination
Not Swollen non tender joints
Second third fourth fifth metacarpalophalengeal joint deformity
Ulnar deviation of 2,3,4,5,mtp
No deformity in thumb
Provisional diagnosis
Investigation
Day 1
Day 2
Treatment
DAY 1
TAB DOLO 650 MG /PO/SOS
INJ NEOMOL 1G/IV/SOS
TEMPERATURE CHARTING
DAY 2
TAB METHOTREXATE 75/OD/ONCE A WEEK
TAB FOLIC ACID 5 MG/ONCE A WEEK
TAB DOLO 650 MG /PO/SOS
INJ NEOMOL 1G/IV/SOS
TEMPERATURE CHARTING
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