Case (22)

[Doctoor]

A 20 years old female brought to emergency department with incomplete loss of consciousness.
the family reported that she quarreled with her fiancee before fainting, and there was past history of 2 similar attacks with no hospitalization.

O/E: Comatose but she blinks her eyes & respond to painful stimuli, her vital signs are normal, nothing abnormality detected on other systems.

Investigation shows:
Hb= 13.5 mg/dl
Random Blood Sugar= 120 mg/dl
Ca+= 9 mg/dl
K+= 4.1  mmol/l
Urea= 25 mg/dl
Creatinine= 0.8 mg/dl

Questions:

1- What is your diagnosis?
2- How are you going to treat this condition?

[Kassim]

What is your diagnosis?

I think this patient had a Seizure  (Generalized tonic-clonic seizure), although there is no sufficient information in this case to confirm the diagnosis.
A clear history from the patient and an eyewitness to the attack give the most important diagnostic information, and loss  of consciousness can be due anything, but given that the pateint had normal lap would suggest epilepsy.
The diagnosis of epilepsy should be made by a neurologist or other epilepsy specialist

Treatment.

If the diagnosis of epilepsy is confirmed, management will include:
in the Emergency Department, that is when the patient is having the seizure, Consider lorazepam 4 mg IV or diazepam 10 mg IV
since the patient had two episode of similar attack assuming it was seizure its time to start Antiepileptic Drug Monotherapy.
Sodium valproate and lamotrigine are drugs of choice. The choice of drug should be tailored to the individual patient and to the epilepsy syndrome and not only to the seizure type.
Patients should be warned of the potential side effects and given clear instructions to seek medical attention urgently for symptoms including rash,
bruising or somnolence with vomiting especially in the first weeks of treatment.

Diet: A ketogenic diet is recommended to improve seizure control,and it was based on the observation that seizures improved during periods of starvation. This diet produces a ketotic state but provides adequate calories for nutrition from proteins and fat. It is used for intractable epilepsy, especially in childhood. It is less commonly prescribed for adults because the diet, being very restrictive, is very difficult to maintain. Studies have shown a substantial reduction in seizure frequency in 50% of patients placed on the diet. Side effects are mainly GI and include bloating, constipation, renal stones, and bone and weight loss. The diet typically contains a fat-to-carbohydrate ratio of 4:1. Urinary ketones are checked daily and need to be greater than 4.

hope this correct unswer.

[Doctoor]

Unfortunately this is not the correct answer, try again

[Dr.Hersi]

diagnosis
 hysteria

treatment

in emergency room ,

In case of hysterical fit, the clothing of the patient should be loosened and her head lowered by laying her out flat at once.
She should not be allowed to assume an erect position for sometimes after the fit. She should be slapped gently in the face and mustard plasers applied to the soles of the feet and the wrists. In ordinary cases no further treatment is necessary and the symptoms will soon pass off or cease if the patient is left alone.
In a genuine hysterical attack, the most effective means of interrupting the paroxym is the applicatin of cold water in some form to the head and spine. Either the cold water may be poured or cold pack or ice pack may be applied to the hand and back of the neck. If this cannot be done, cold water may be splashed on the face. The patient should be provided with plenty of fresh air and some of her clothing should be removed to facilitate easy breathing and to expose the skin to fresh air.

 

later on :
Hysteria is curable in nearly all cases. Since the causes of hysteria are both physical and mental, treatment should be directed toward both the body and the mind. Regard for one’s physical welfare is of primary importance. 
The measures on the physical side should include a well- ordered hygienic mode of living, a nutritious and bland diet, adequate mental and physical rest, daily exercise , agreeable, occupation, fresh air, regular hours of eating and sleeping, regulation of the bowels and wholesome companionship with others.
 
On the mental plane, the patient should be taught self-control and educated in positive thinking. Her mind must be , by some means drawn away from herself. ,
In most cases of hysteria, it is desirable for the patient to start treatment by adopting an all-fruit diet for several days.

Exercise and outdoor games are important in the prevention and cure of hysteria .
They take the mind away from one’s self and induce cheerfulness. ,
 Weak patients, who are not able to take much active exercise , may be given massage three or four times a week.
 Other measures useful in the treatment of hysteria are air and sun baths.
. Daily cool baths are also an excellent tonic. Suitable physical activity must be balanced with adequate rest and sleep.

[Doctoor]

congratulation dr.hersi
I think you deserve the 15 points