ALTERED SENSORIUM UNDER EVALUATIONK/C/O-GOUTY ARTHRITIS SINCE 4 YRS? STEROID INDUCED PSYCHOSISDENOVO HTN

ADMISSION UNDER UNIT 6

A 38 Yr Male, Toddy climber by occupation came to casuality on 11/9/21 at 4:30 pm in unresponsive state since 30 minutes
Pt was apparently asymptomatic till 2pm on 11/9/21. Pt had alcohol intake on 10/9/21 night→ followed by, he woke up 11/9/21 morning, done his routine works and had food and went to bed at 1pm f/b he had 2 episodes of vomitings- non bilious, non projectile, food as contents, non- blood tinged.
After vomiting, patient became unresponsive.
   Not responding to oral commands with GCS as E1V1M2
       On presentation to casuality, pt- stuporous, vital - stable 
pupils : B/L dilated, sluggish to light reaction )

H/0-?Gouty Arthritis since 4 years and on tab. Febuxistat

- H/O Recurrent joint swellings from Local RMP he received Injections for swelling ? Diclofena- Steroid injection(Decadion)

Around 9 pm pt became conscious but so irritable and not oriented to time, place and person

Psychiatric opinion is taken 
?steroid induced psychosis
Inj.Haloperidol 5mg//IM/stat and inj.promethazine 25mg/IM/stat given 

Patient became conscious at 11 pm from then he is oriented to time, place and person

GCS-E4V4M5
 
Diagnosis-
ALTERED SENSORIUM UNDER EVALUATION
K/C/O-GOUTY ARTHRITIS SINCE 4 YRS
? STEROID INDUCED PSYCHOSIS
DENOVO HTN
Past history-
Not a known case of diabetes ,hypertension,asthma , convulsions
• Surgical history is not significant.      

Family history 
          Not significant 

Personal history 

•  appetite normal
• Mixed diet
• Regular bowel habits and normal 
• He is an alcoholic since 10 years , drinks once weekly -BEER , WHISKEY
 

 GENERAL EXAMINATION 

   Patient is conscious coherent and cooperative , moderately built , moderately nourished 
⁃ No pallor 
⁃ No icterus , no cyanosis, no clubbing ,no pedal edema 
⁃ No generalized lymphadenopathy     

CVS EXAMINATION 
 
⁃ S1 s2 heard 
⁃ No murmurs 
⁃ No palpable thrills 

ABDOMINAL EXAMINATION 

 Scaphoid shape 
No tenderness 
No palpable mass 
No hepatosplenomagaly 
No ascites 
Bowel sounds present 

CNS EXAMINATION 

In Unresponsive state
⁃ No signs of meningeal irritation 
ECG ON PRESENTATION

ECG ON NEXT DAY MORNING AT 9 AM






 

Psychiatry opinion is taken I/v/o irritability after alcohol consumption

1) INT. HALOPERIDOL 2.5mg (1/2amp) IV/ STAT

2) INT. PROMETHAZINE 25mg IM STAT

MONITOR VITALS 2HRLY.
Review sos

OPHTHALMOLOGY OPINION TAKEN

ORTHOPAEDIC REFFERAL


SOAP NOTES DAY 1

SUBJECTIVE- 
UNCONSCIOUS AT PRESENTATION...
AT 9 PM BECAME CONSCIOUS AND IS IRRITABLE
NOT ORIENTED TO TIME PLACE AND PERSON...
AT 11PM BECAME CONSCIOUS AND WELL ORIENTED
OBJECTIVE- 
Temp -Afebrile
PR- 90 Bpm, regular .
BP-150/90 mmHg 
RR-22 cpm
Spo2- 98 @ROOM TEMPERATURE

ASSESSMENT:-
ALTERED SENSORIUM UNDER EVALUATION
K/C/O-GOUTY ARTHRITIS SINCE 4 YRS
? STEROID INDUCED PSYCHOSIS
DENOVO HTN
PLAN OF CARE:-
DAY 1
INJ.THIAMINE 300mg in 100ml NS/IV/STAT
INJ.OPTINEURON 1 AMP IN 100ML NS
 INJ. HALOPERIDOL 5mg (1amp) IV/ STAT
INJ.LORAZEPAM 2CC IV/SOS
INJ. PROMETHAZINE 25mg IM STAT
INJ.THIAMINE 100MG/IV/TID
INJ.PAN 40MG IV/OD
INJ.ZOFER 4MG IV/SO
.MONITOR VITALS 2ND HRLY
   TEMP CHARTING


SOAP NOTES DAY 2

SUBJECTIVE- 
CONSCIOUS
NO FRESH COMPLAINTS
OBJECTIVE- 
Temp -Afebrile
PR- 94 Bpm, regular .
BP-150/80 mmHg 
RR-22 cpm
Spo2- 98 @ROOM TEMPERATURE

ASSESSMENT:-
ALTERED SENSORIUM UNDER EVALUATION
K/C/O-GOUTY ARTHRITIS SINCE 4 YRS
? STEROID INDUCED PSYCHOSIS
DENOVO HTN
PLAN OF CARE:-
DAY 2
1-ORAL FEEDING
2-INJ.THIAMINE 100MG/IV/TID
3-INJ.PAN 40MG IV/OD
4.INJ.ZOFER 4MG IV/SOS
5.TAB.CINOD 10MG PO/OD
6.TAB.FEBUXOSTAT 40MG PO/BD
7.MONITOR VITALS 2ND HRLY
   TEMP CHARTING


SOAP NOTES DAY 3

SUBJECTIVE- 
CONSCIOUS
NO FRESH COMPLAINTS
OBJECTIVE- 
Temp -Afebrile
PR- 88 Bpm, regular .
BP-140/90 mmHg 
RR-22 cpm
Spo2- 98 @ROOM TEMPERATURE

ASSESSMENT:-
ALTERED SENSORIUM UNDER EVALUATION
K/C/O-GOUTY ARTHRITIS SINCE 4 YRS
? STEROID INDUCED PSYCHOSIS
DENOVO HTN
PLAN OF CARE:-
DAY 3
1-ORAL FEEDING
2-INJ.THIAMINE 100MG/IV/TID
3-INJ.PAN 40MG IV/OD
4.INJ.ZOFER 4MG IV/SOS
5.TAB.CINOD 10MG PO/OD
6.TAB.FEBUXOSTAT 40MG PO/BD
7.MONITOR VITALS 2ND HRLY
   TEMP CHARTING

SOAP NOTES DAY 4

SUBJECTIVE- 
CONSCIOUS
NO FRESH COMPLAINTS
OBJECTIVE- 
Temp -Afebrile
PR- 88 Bpm, regular .
BP-140/90 mmHg 
RR-22 cpm
Spo2- 98 @ROOM TEMPERATURE

ASSESSMENT:-
ALTERED SENSORIUM UNDER EVALUATION
K/C/O-GOUTY ARTHRITIS SINCE 4 YRS
? STEROID INDUCED PSYCHOSIS
DENOVO HTN
PLAN OF CARE:-
DAY 4
1-T.MVT PO/OD -30 DAYS 
2-T.GOUTNIL 0.5MG 
     1-X-1 -3 DAYS F/B
      1-X-X. -3 DAYS
3-T.PAN 40MG PO/OD
4.T.ZOFER 4MG IV/SOS
5.T.CINOD 10MG PO/OD
6.TAB.FEBUXOSTAT 45MG PO/BD -15 DAYS 
7.T.INDOCAP SR 75MG OD/MORNING- 7 DAYS

SR.URIC ACID-8.8
REPEAT AFTER 2 WEEKS 
DISCHARGE SUMMARY

A 38 Yr Male, Toddy climber by occupation came to casuality on 11/9/21 at 4:30 pm in unresponsive state since 30 minutes
Pt was apparently asymptomatic till 2pm on 11/9/21. Pt had alcohol intake on 10/9/21 night→ followed by, he woke up 11/9/21 morning, done his routine works and had food and went to bed at 1pm f/b he had 2 episodes of vomitings- non bilious, non projectile, food as contents, non- blood tinged.
After vomiting, patient became unresponsive.
   Not responding to oral commands with GCS as E1V1M2
       On presentation to casuality, pt- stuporous, vital - stable 
pupils : B/L dilated, sluggish to light reaction )

H/0-?Gouty Arthritis since 4 years and on tab. Febuxistat

- H/O Recurrent joint swellings from Local RMP he received Injections for swelling ? Diclofena- Steroid injection(Decadion)

Around 9 pm pt became conscious but so irritable and not oriented to time, place and person

Psychiatric opinion is taken 
?steroid induced psychosis
Inj.Haloperidol 5mg//IM/stat and inj.promethazine 25mg/IM/stat given 

Patient became conscious at 11 pm from then he is oriented to time, place and person

GCS-E4V4M5
 
Diagnosis-
ALTERED SENSORIUM UNDER EVALUATION
K/C/O-GOUTY ARTHRITIS SINCE 4 YRS
? STEROID INDUCED PSYCHOSIS
DENOVO HTN
TREATMENT GIVEN
DAY 1
INJ.THIAMINE 300mg in 100ml NS/IV/STAT
INJ.OPTINEURON 1 AMP IN 100ML NS
 INJ. HALOPERIDOL 5mg (1amp) IV/ STAT
INJ.LORAZEPAM 2CC IV/SOS
INJ. PROMETHAZINE 25mg IM STAT
INJ.THIAMINE 100MG/IV/TID
INJ.PAN 40MG IV/OD
INJ.ZOFER 4MG IV/SO
.MONITOR VITALS 2ND HRLY
   TEMP CHARTING
DAY 2
1-ORAL FEEDING
2-INJ.THIAMINE 100MG/IV/TID
3-INJ.PAN 40MG IV/OD
4.INJ.ZOFER 4MG IV/SOS
5.TAB.CINOD 10MG PO/OD
6.TAB.FEBUXOSTAT 40MG PO/BD
7.MONITOR VITALS 2ND HRLY
   TEMP CHARTING

DAY 3
1-ORAL FEEDING
2-INJ.THIAMINE 100MG/IV/TID
3-INJ.PAN 40MG IV/OD
4.INJ.ZOFER 4MG IV/SOS
5.TAB.CINOD 10MG PO/OD
6.TAB.FEBUXOSTAT 40MG PO/BD
7.MONITOR VITALS 2ND HRLY
   TEMP CHARTING
DAY 4
1-T.MVT PO/OD -30 DAYS 
2-T.GOUTNIL 0.5MG 
     1-X-1 -3 DAYS F/B
      1-X-X. -3 DAYS
3-T.PAN 40MG PO/OD
4.T.ZOFER 4MG IV/SOS
5.T.CINOD 10MG PO/OD
6.TAB.FEBUXOSTAT 45MG PO/BD -15 DAYS 
7.T.INDOCAP SR 75MG OD/MORNING- 7 DAYS

ADVICE AT DISCHARGE
1-T.MVT PO/OD -30 DAYS 
2-T.GOUTNIL 0.5MG 
     1-X-1 -3 DAYS F/B
      1-X-X. -3 DAYS
3-T.PAN 40MG PO/OD
4.T.ZOFER 4MG IV/SOS
5.T.CINOD 10MG PO/OD
6.TAB.FEBUXOSTAT 45MG PO/BD -15 DAYS 
7.T.INDOCAP SR 75MG OD/MORNING- 7 DAYS

SERUM URIC ACID-8.8 AT PRESENTATION TO HOSPITAL
REVIEW AFTER 2 WEEKS TO ORTHO OP WITH SERUM URIC ACID LEVELS TEST

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