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. .


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.

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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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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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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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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
1)In SA nodal exit blocks, either SA Wenkebachs or SA exit type 2b ,their as to be Sinus p waves...which is not the case here...2nd and 3rd p waves in a group are not appearing to be Sinus p waves 2)D/D's for grouped beats includes a)Mobitz av blocks b) APC's 3)Hypokalemia never causes SA nodal exit blocks where as hyperkalemia affects both SA and AV
k . Thank you sir
Nice case sir but do see how it it is AV block can't identify a blocked p wave and when u are talking about ectopics as a cause of pause, do u mean patient has atrial trigeminy or non conducted apc or two atrial ectopics following a NSR beat because these are the only possibility, which I can see why no sinoatrial block kindly clarify sir
It's Atrial couplets sir

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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
SPO2, ,???ANY H/O FEVER,,LM, ,DOE,,severe vomitting leads to electrolyte imbalance, ,s. electrolyte to be done, ,,,PUT HIM ON IVF AND INOTROPES TO RAISE HIS BP AND RESTORE NORMAL HR, ,INJ ADRENALINE STAT, ,INJ atropin stat, ,iv emset, ,iv pantodac, ,
Thanks sir
@Dr.suresh , In long lead 2 u can observe grouped beats... In those beats , 2nd and 3rd p waves are Non sinus p waves as evidenced by different Marphology of p waves. It's not Mobitz av block...as p-p intervals are not constant
Thank you so much for ur valuable discussion sir
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