Concluded Case

Dry mouth Dry nose Sleeplessness

Male patient of age 60 Chief Complaints Recurrent dry mouth Dry nose Anxiety Sleeplessness Loss of appetite Since long History History of taking various medication for same problem from different speciality but symptoms not resolve Patient now losing hope Vitals Bp normal Pulse normal Physical Examination Bowel decrease Urine frequency increase App low Sleep less All symptoms since long Investigations Cbc: hb10 Lft sgot sgpt 45/70 Kft NAD Bs pp fasting normal Xray pns deviated nasal septum Diagnosis Anxiety disorder??? Sjogren??? Management Recently take Tab:pan 40 Tab: Shelcal d3 Tab:ironmax Tab: lorazepam 1 mg hs Tab:pilocarpine but developed rash over head and watery eyes after taking this med Symptoms yet continue Need to be discussed very urgent

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Concluded answer

Anemia, raised hepatic enzymes , DNS Need to investigate these findings . ANA profile and Rheumatologist opinion to rule out Sjogren syndrome ,especially anti Ro - SSA and anti La - SSB and RA . Ophthalmologists opinion for conjunctival dryness. Dental consultation for salivary secretions Lip biopsy can be confirmatory. DD Nasal block caused by DNS, and Obstructive Sleep Apnoea can also give rise to same symptoms. ENT opinion and poly sonography needed . DD Anxiety ,GAD , Psychiatric assessment . Suggest increase fluid intake Advised to suck lemon peels. Refresh eye drops Steroid+ antihistamines nasal spray

All Answers

He is most likely a c/o IGT Needs frequent visits of counseling and modifying lifestyle Yes more of anxiety disorder hence good anti depressants at bed time Any recent past h/o fever or covid infection

There is no history of fever of any chest infection
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Anemia, raised hepatic enzymes , DNS Need to investigate these findings . ANA profile and Rheumatologist opinion to rule out Sjogren syndrome ,especially anti Ro - SSA and anti La - SSB and RA . Ophthalmologists opinion for conjunctival dryness. Dental consultation for salivary secretions Lip biopsy can be confirmatory. DD Nasal block caused by DNS, and Obstructive Sleep Apnoea can also give rise to same symptoms. ENT opinion and poly sonography needed . DD Anxiety ,GAD , Psychiatric assessment . Suggest increase fluid intake Advised to suck lemon peels. Refresh eye drops Steroid+ antihistamines nasal spray

Thank you doctor
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i think first try to find out has the patient been abusing some kind of anticholinergic medications/tca s like amitryptyline from a long time.sometimes due to anxiety issues many patients are prescribed tca s with benzodiazepines and tca s have got anticholinergic properties giving rise to dry mouth,constipation and if with benzo abrupt stopping can lead to sleeplessness,restlessness etc.SJOGREN syndrome shud definitely be ruled out.

Thank you doctor
1

Any long standing history of snoring

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