21 yr old male presenting with intentional tremors of tongue,lip and fingers,urinary incontinence,fatigue throughout the day,GERD, On examination BP 120/100 pulse :normal range pls DX .@

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ECG grossly normal.... Causes of Intention tremors in such a young female can be difficult... Intention tremors have a variety of causes. These include a variety of neurological disorders, such as stroke, alcoholism, alcohol withdrawal, peripheral neuropathy, Wilson's disease, Creutzfeldt–Jakob disease, Guillain–Barré syndrome and fragile X syndrome, as well as brain tumors, low blood sugar, hyperthyroidism, hypoparathyroidism, insulinoma, normal aging, and traumatic brain injury....

Chest leads r recorded at 5mm/mv But its normal Two imp findings Intentional tremor & incontinece of urine So need to check MRI & EEGof brain to ruled out any CNS problem followed by Psychiatric evaluation & toxic screen for drug abuse

I’d definitely suggest to get his LFTs done and Look for KFR by slit lamp exam. Next step would be to get his MRI brain. Iron profile is another approach.

Why kfr ,sir?
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ECG is normal.. Pt. May have taken over doses of B.Agonistic Medicines. So take his complete history weather he has Taken any cough syrep ?

No
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Very vague history Labs seem WNL r/o epileptic seizures also check urine metanephrines and VMA. r/o pheochromcytoma

Most probably Alcoholic deaddiction&counselling-exclude metabolic disorders esp ly THYROID

ECG is normal.Please go for thyroid profile

Thyroid profile also normal
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Serum ammonia and KFT?

CLONAZIPAM

History is incomplete. What about the duration of symptoms? History of tobacco or alcohol withdrawal?

For 2 years
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