15 yrs old male pt has admitted with the complaints of vomiting 4 times followed by inability to use the lower limbs initially within one hr both upper limbs also. .quadriparesis. . pulse..irregular. BP ..96/70 mmhg. . ecg shows arrhythmia. . 1.. what are the clinical conditions that will affect both heart and nervous system. ..how will you differentiate clinically? 2..how to approach this pt? 3. ecg findings? 4..investigations and treatment? plz share your views. ...Thanks in advance. .

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This is a case of Hypokalemia followed by vomitings. 1 Hypokalemia followed by vomitings 2 Guillian barre syndrome begins with tingling, numbness, weakness in legs and feet with progression to upperlimb and breathing difficulty. 3 Dengue fever include fever,severe joint pain,muscle pain, head ache, lymphnodes swelling, rash ,hemmorhagic sometimes. 4 Coarctation of aorta is a congenital disorder where we find narrowing of aorta and decreased blood supply,we find high blood pressure and heart damage and acute hemorrhagic stroke. 5 Acute disseminated encephalomyelitis present as fever,headache on and off,vomitings, irritability, weakness of limbs 6Cerebral malaria associated with fever with cerebral atrophy 7 Intracranial space occupying lesions present as headache, vomitings and visusl disturbances 8 Rarely sjogrens syndrome 9 Trauma to head 2 Proper history of the case clinical examination Cranial nerve examination Reflexes 3 ECG findings Decreased T wave arrythmia prolonged PR interval Tall R wave in V5 and V6 4 Investigations CBP Peripheral smear for MP Dengue seral virology FPG PPG HBA1C RFT Serum electolytes LFT TFT ECG ,2D ECHO CUE X ray chest CSF analysis CT / MRI BRAIN Treatment is Treat the underlying cause correct dehydration correct electrolytes particularly potassium intravenously to get rapid improvement in condition.

NICE MAM, ,EXPLAINED NICELY AND ELABORATELY, ,CORRECT LINE OF MANAGEMENT
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Here there is rapidly progressive ascending paralysis. dds 1,GBS which affects autonomic nervous system hence HR irregular 2,Hypokalemia is one more possibility but there is only vomiting 3,transverse myelitis invesigations. CSF analysis electrolytes watch for cranial nerve palsies be ready for ventilation if impending facial paralysis thank you

Wonderful analysis
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15 yrs old male pt has admitted with the complaints of vomiting followed by quadriparesis. . no h/o fever. .headache. seizure. .trauma history. . acute onset of quadriparesis with pt is conscious. .no sensory. .bladder or bowel involvement. . DDS .. 1 . electrolytes disorders. . hypokalemia. .common hyperkalemia also...rare hypo or hypernatremia 2. thyroid disorders 3. CNS disease. transverse myelitis ischaemic or traumatic cord palsy 4.GBS 5. diseases of NM junction myasthenia gravis lambert Eaton syndrome 6. muscle disorders. . channelopathies myopathies 7. systemic envenomation snake bite tick paralysis scorpion bite 8. opc poisoning. . pt was admitted on 21.07.2016 pt conscious quadriparesis power 2/5 all 4 limbs. . ecg was already posted shows U waves in lead v 4.5.6. Two possibilities. . 1 . second degree AV block type 2. 2.APC S.. whenever there is grouped beats these are DDS. .not AF. investigations report attached. . final diagnosis. .hypokalemia

what is the cause for hypo kalemia. other than vomiting in this pt sir
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it's rapidly progressing ascending paralysis.. with h/ o vomitting , most common cause may be severe hypokalemia. urgent Sr K advised.. HYPOKALEMIA can also cause arythmias.

Thank you so much sir. ..any other DD sir ?
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pt has no fever or joint pain ..no neck stiffness no sensory loss no bowel or bladder involvement. . deep tendon reflexes. .absent

points towards GBS did Sr potassium reports come???
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Thanks for sharing the treatment, latest reports and recovery in this case, Dr suresh. Hypokalemia induced quadriparesis is reversible with potassium infusion

Thank you so much madam and sir for sharing ur valuable opinion and guidance to improve our knowledge. .
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It's is a case acute flaccid quadreperesis with no bladder and bowel involvement with ecg suggestive of sinoatrial exit block I think if potassium is ok GBS has to be frist diagnosis needs NCV to confirm neuropathy

1 VALVULAR HEART DISEASE IHD CARDIOMYOPATHY WITH CEREBRAL EMBOLISM FROM LEFT ATRIAL OR VENTRICULAR THROMBUS ECHOCARDIUM CAN GIVE US CLUE 2 ECG ECHOCARDIUM MRI BRAIN 3 ECG = SSS ATRIAL PACEMAKER AT LEAST FROM 3 SOURCES WITH DIFFERENT SHAPE P R INTERVAL IN TRIGEMINAL RHYTHM WITH SINUS ARREST AFTER EACH TRIGEMENY HERE IN THIS PT PT HAD VOMITING ---------> PARAPLEGIA THERE PROGRESSED TO QUDRAPLEGIA POSSIBLITIES 1 GULLAIN BARRAE SYNDROME 2 HYPOKALAEMIA 3 BASILAR ARTERY INVOLVEMENT EMBOLISM 4 VOMITINGMAY BE DUE TO RAISED INTRACRANIAL PRESSURE OR OTHER CAUSE MAY BE THERE VOMITING CAN LESD TO HYPOKALAEMIA ---------------------------------------------------- INVESTIGATIONS 1 BLOOD = K + Na + SUGAR 2 ECHOCARDIUM 3 MRI BRAIN & MRA BRAIN CARITIDS VERTEBRAL BASILAR ARTERIES 5 MRI CEREBRAL VENOUS SINUSES 6 CSF = ANY ALBUMINOCYTOLOGICAL DISSOCISION

missing lead 1, avr, v3 rhythm in the form of Group beating each of three beat followed by long pause but in pause i can't see block P wave so difficult to Say WENCHEBACK here Qt is normal but there's large U wave present so check S.K, S.MG if normal think of neurology

Thanks sir
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Considering the clinical scenario, s/o Hypokalemia Periodic Palsy even considering the age of onset Ascending pattern of paralysis I need to know regarding Deep tendon reflexes... whether preserved or Lost? ecg S/o Premature Atrial Ectopics which can again be due to Hypokalemia with prominent u waves In some leads amplitude of u waves exceeding T waves

dr.sandeep sir..ecg shows PAC Or AV block
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