30M with involuntary movements of hands,tingling in upper limbs

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A 30 year old male came to general medicine opd with  

Chief complaints: 

Involuntary movements of hands and tingling and numbness in upper limbs and abdomen since 1 day  

History of presenting illness : 

Patient was apparently asymptomatic 20 days back then He developed fever insidious in onset, gradually progressive, low grade , intermittent not associated with chills and rigors and relieved by medication.He has a history of 4-5 episodes of vomitings 5 days back. Watery, non bilious ,non projectile, with food particles as contents.

And had a history of visit to nagarkurnool and consumed food there and due to water change patient also had hoarseness of voice 

Relieved by medication (unknown)

No c/o pain abdomen, loose stools  

c/o burning micturition 2 days back, relieved now

H/o similar complaints in the past(7 years back) (hypokalemiac periodic paresis)

No h/o DM,HTN, asthma, epilepsy,cad, thyroid disorders 

He used to take alcohol occasionally for the past 10 years and stopped  1 month back

He takes tobacco once in 2 days for the past 10 years 

Patient is not co operative to let me take clinic images of chest and abdomen

O/E 

Patient is conscious, coherent and cooperative well oriented to time ,place and person

No signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy,edema

Vitals:

BP - 100/70mm hg

PR- 86 bpm

RR- 16 cpm

CVS EXAMINATION:

S1,S2 heard no murmurs

RS EXAMINATION:

trachea central

NVBS +

BAE +

P/A EXAMINATION:

Soft, non-tender

Bowel sounds heard

CNS EXAMINATION:

Hyporeflexia (due to hypokalemia) is 

 Investigations 

Day 1 

Serum electrolytes

   Na - 139 mEq/L

   K -2.3 mEq/L

  Ca - 1.01 mmol/L

  Mg - 2.0

Urinary electrolytes

  Na- 162 

  K - 7.3 

  Cl - 123

Urine Ph - 7.0

Serum electrolytes :  

ECG

CBNAAT REPORT

Acid fast bacilli

Xray chest PA View

Consolidations in the left upper lobe 

B/L hilar shows normal in size 

Trachea central in position 

Cardiac size is normal 

Right lung shows normal translucency 

TREATMENT:

1)Inj. Kcl 50 mEq in 500 ml NS / IV over 5 hours

2) Inj. Zofer 4mg iv/OD 

3)Inj. Pan 40 mg IV/OD

AMC-30 YR M

C/O PAIN ABDOMEN 

ON EXAMINATION:

PATIENT IS C/C/C

TEMP: 98 F

BP:100/70 mmHg

PR:86 BPM

RR: 16CPM

CVS:S1,S2 HEARD ,NO MURMURS 

RS:BAE+,NVBS, NO ADDED SOUNDS

P/a: SOFT, NON TENDER

CNS:

 TONE NORMAL IN ALL LIMBS

POWER 5/5 IN ALL LIMBS 

Provisional Diagnosis:

HYPOKALEMIA UNDER EVALUATION