36 YEAR OLD FEMALE WITH AIDP -AMAN VARIANT
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Here is a case i have seen:
36 yr old woman from narketpally, coolie by occupation came with
c/o pain in bilateral upper limbs and lower limbs since 1 week.
Unable to walk without support since 5 days.
Unable to sit without support since 5days .
Unable to hold chappal since 5 days .
Patient works as a coolie at narketpally, Nalgonda District. She attained menarche at 13 years of age and got married when she was 15 years of age. Her husband works as a coolie and they have 3 children ( daughters ). Her first 2 deliveries were normal vaginal deliveries. Her third daughter was born out of LSCS.
HOPI:
She was apparentely completely alright until 6 months back, then she developed numbness in both her lower limbs one day when she was at work and gradually she developed pain in all her lower limbs over a span of 10 days ,after which she slowly developed weakness in bilateral lower limbs which progressed to involve her upper limbs. She was unable to walk without support, she says she even had multiple joint pains back. She was immediately rushed to a hospital where in she was told that her serum pottasium was low and she was given certain oral medications.
20 days back her husbands father expired after which she took shower in cold water after which she developed chest pain after taking shower in cold water. She also started feeling Dyspneic. She had no complaints of fever, cough. She was taken to a local hospital where in she was told that she had pleural effusion and was put on Tab.Dytor plus.
Since 1 wk she has been having bilateral LL pain which gradually progressed to weakness of lower limbs followed by upper limbs over a span of 5 days.She started finding it hard to sit without support and was unable to walk and sit without support and even to drape her saree. She found it hard to eat by herself because she was not able to hold food in her hand so her daughter started feeding her. She was unable to hold her chappal and it would often slip away .
Since last night, she has been feeling dyspeneic at rest along with non productive cough.
Since 9am this morning, she tried to get up from her bed, she found it hard even to sit with support
She gives no complaits of preceding fever, over the counter usage of drugs, family history.
She is Not diabetic, non alcoholic.
No complaints of difficulty in swallowing or
phonation of voice or diplopia
past treatment history:
k/c/o hypothyroid since 3 yrs and on tab thyronorm 25 mcg / od
not k/c/o HTN,DM,TB,asthma,epilepsy.
GENERAL EXAMINATION:
pt is c/c/c
Pallor +
no icterus,cyanosis,clubbing,lymphadenopathy,edema .
Pupils bilaterally reacting to light
systemic examination:
CNS:
Tone reduced in all the limbs
Power. Rt. Lt.
Upper. 2/5. 2/5
Lower 2/5. 2/5
Reflexes-- Areflexia
Plantars - Extension
sensory examination :
Fine touch, crude touch and temp - Intact
Vibration and proprioception - lost
Cranial nerves intact
Cvs - S1, S2 +
RS : - Inspiratory crepts in all the lung fields
Provisional Diagnosis:
AIDP --AMAN variant
INVESTIGATION:
CBP:
RFT:
LFT:
RBS:
Thyroid profile:
chest x ray:
Treatment :
DAY 1:
1) INJ OPTINEURON 1 AMP IN 100 ML NS SLOW IV
DAY 2:
no fresh complains
she feels better than yesterday
1) INJ OPTINEURON 1 AMP IN 100 ML NS IV /OD
2) TAB PANTOP 40 MG /PO/BBF
8 am ----------x---------------x
3) TAB METFORMIN 500MG /PO/OD
DAY 3:
1) INJ OPTINEURON 1 AMP IN 100 ML NS IV /OD
2) TAB PANTOP 40 MG /PO/BBF
8 am ----------x---------------x
3) TAB METFORMIN 500MG /PO/OD
8 am -----------x---------------x
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