Complex comatose CKD case

 This isvour current ICU patients who has been stuck to the ventilator and is comatose for quite some time.

https://sufialmas.blogspot.com/.../65-year-old-male...

It would be nice to have your inputs

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65 year old male,chronic alcoholic with chronic kidney disease living with diabetes,hypertension .

65 year old male ,farmer by occupation was brought to the casuality in an altered state with a low G C S since 1 day. ...

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• Atri Chatterjee

  The unfortunate patient had a symptom of neck rigidity which was corroborated on clinical examination. He is also immunocompromised due to diabetes and alcoholism. There is evidence of infection in his blood investigations. In this scenario, the most important differential is CNS infection. As the imaging does not show any sign of raised ICT, a CSF study is appropriate. However, as the patient is already on antibiotics, results of CSF study may not be classical.

  

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• Rakesh Biswas

  Admin

  Thanks Dr 

  Atri

  . His neck rigidity is as in this image https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcTjMAIZ7wxzLaHphPfaCYY6SDOe9SYhgZNcFMsBLnl4QXkKZnQu which. means his head doesn't touch the bed when we remove his pillow. His CT findings of the axial skeleton suggests diffuse skeletal hyperostosis that could be a result of the fluorosis that is quite common here as he's from district Nalgonda. His neck is practically ankylosed.

  He didn't have kernigs or brudzinski's sign. I shall ask our resident to post his CT images depicting the skeletal hyperostosis changes around his vertebra. He must be having ossified posterior longitudinal ligament

  

  ENCRYPTED-TBN0.GSTATIC.COM

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• Xilia Faye

  What kind of farming did he do and was there potential chemical exposure?

  

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• Rakesh Biswas

  Admin

  One important point in this patient that has not been highlighted is the fact that he presented to the casualty this time with Hemiballismus like abnormal movements (we have a video that will need editing from 

  Avinash Kumar

  ) and a blood sugar of 700 mg%. Google Hemiballismus and hyperosmolar non ketotic and see?

  

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  • Xilia Faye

    Rakesh Biswas

     in this one it looks like the patient reacted to a different antibiotic but responded to the one used here- (predisposition) but the treatment used was intersting to me. https://www.hindawi.com/journals/crim/2018/8439791/

    

    HINDAWI.COM

    Severe Drug-Induced Agranulocytosis Successfully Treated with Recombinant Human Granulocyte Colony-Stimulating Factor

    Severe Drug-Induced Agranulocytosis Successfully Treated with Recombinant Human Granulocyte Colony-Stimulating Factor

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• Xilia Faye

  As a follow up- this patient has now passed.