17 YEARS OLD FEMALE WITH LOOSE STOOLS AND VOMITING SINCE 1 WEEK.

 

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CASE:- 

17 year old female complaining of loose stools and vomiting since 1 week.

 CHIEF COMPLAINTS:- 

•loose stools since 1 week

•vomiting since 1 week

•fever since 3 days.

HISTORY OF PRESENTING ILLNESS:- 

Patient was apparently asymptomatic One week back,she had outside food followed by which she developed loose stools and vomitings.

Loose stools:- 4-5episodes, water in consistency, non foul smelling, no blood tinged.

Vomitings:- 4-5 episodes, non projectile, non bilious, contents include food particles,Which subsided on taking medication,

Fever was incidious in onset, associated with chills and rigor,which subsided on taking medication

10years back,patient's mother observed swelling over the neck 4*4cm approximately and was diagnosed with HYPOTHYROIDISM and was on TAB.THYROXINE 25mcg....

Patient has history of eating slate pencils since 4 years.(5-6 slate pencils per day)

3 years ago :- history of itching and was taken to hospital which subsided on taking medication.

Since 3months patient is observing irregular menses,followed by dysmenorrhea,with clots.

Patient also complained of generalised weakness since 1week

HISTORY OF PAST ILLNESS:- 

☆ Known case of hypothyroidism since 10 years and is on TAB. Thyroxine 25mcg

☆not a Known case of Diabetes mellitus, hypertension,  asthma , epilepsy.

PERSONAL HISTORY:-

Diet:- mixed( non veg 2 times weekly)

Appetite:- normal

Sleep:- adequate

Bowel and bladder movements:- Regular

Addictions :- no Addictions

Allergy:- present 3 years ago, but subsided on taking medication.

FAMILY HISTORY:- 

mother was a Known case of hypothyroidism and was on Tab. Thyroxine 100 mcg

GENERAL EXAMINATION:- 

Patient was conscious, coherent ,cooperative, well oriented to time , place and person.

Pallor:-++

• Hyperpigmentation dots present over the buccal mucosa in the oral cavity.

• knuckle pigmentation was present.

•Acanthosis Nigricans ++

Icterus:- absent

Cyanosis:-absent

Clubbing:-absent

Lymph nodes:- bilateral cervical and submandibular lymph nodes palpable.

VITAL SIGNS:-

BP:-supine:- 130/80 mmhg

        Standing:- 120/60 mmhg

Pulse rate:- supine:- 88BPM

                     Standing:- 83 BPM

spo2:- 98%

Respiratory rate:- 18CPM

GRBS:- 98mg /dl

SYSTEMIC EXAMINATION:-

CVS:S1,S2 heard,no murmurs

RESPIRATORY SYSTEM:

Inspection: trachea central in position

Normal vesicular breath sounds heard

BAE ++

LOCAL EXAMINATION:

Inspection:swelling at the anterior part of the neck,does not move with protrusion of tongue and moves with deglutition

Palpation :- disseminated margins,nodular,

                        size:6*7cms

Percussion :- 

Auscultation :- no bruits

ABDOMINAL EXAMINATION:

Inspection :- no scars

Palpation :- soft,non tender

Auscultation :- BOWEL SOUNDS HEARD 

CNS EXAMINATION:

CRANIAL NERVES: INTACT 

Power

Rt UL-5/5. Lt UL-5/5 

Rt LL-5/5. Lt LL-5/5 

Tone-

Rt UL -N,Lt UL-N

Rt LL-N,Lt LL-N

Reflexes:. RIGHT LEFT

Biceps. ++ ++

Triceps. ++ ++

Supinator. ++ ++

Knee. ++ ++

Ankle. ++ ++

Plantar:. Flexion Flexion       

•SENSORY

crude touch N N

              Pain N N

Temperature N N

     Fine touch N N

       Vibration Right Left

     Upper limb. 15 sec 15 sec

     Lower limb. 11 sec. 10sec

                Tibia. 14 sec. 14sec

                   Toe. 15sec. 15sec

Finger nose co-ordination : +

INVESTIGATIONS:-

Haemogram:-

Serumiron:- 

Ferritin levels:-

Phosphorus levels:-

Serum calcium:- 

Ultrasound Neck:-

Chest xray:-

Peripheral smear:-

Diagnosis:- Dimorphic anemia.

ECG:- 

DIAGNOSIS:-

Acute Gastroenteritis resolving with pernicious anemia with autoimmune thyroiditis ?

Addison's disease ?

TREATMENT:

1.NALMOL 

2.TAB.PANTOP 40mg BD

3.TAB.ZOFER 4mg SOS

4.TAB.SPOROLAC (ROUTE:PERORAL) BD

5.TAB.DOLO 650mg SOS

6.TAB.THYRONORM 25mcg OD

7.ORS SACHET IN 1LT WATER TO DRINK AFTER EACH LOOSE STOOLS.

8.VITALS STORING EVERY 4TH HRLY