Monocrotophos poisoning ,headache under evalution

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01/12/22

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

CASE:

A 48 yr old male resident of kishthapuram ,farmer by occupation came with chief complaints of  

Bilateral upper limb and lower limb dragging sensation ,headache and backache since 20days.

HOPI-

Patient was apparently asymptomatic 20days back.Then he developed bilateral upper &lower limb dragging limb sensation.Back pain , headache and  had  2 episodes perday  of voimting for 4days  after spraying monocrotophos in his cotton field and he worked without protective equipment.

Associated with episode of vomiting is non projectile,non bilious  and water as content.

The very next morning at 5AM he got up and had episodes of vomiting and came to our hospital .

He got treated and discharged and he was under medication.

On 26/11/12  he again came to our hospital with the similar complaints , took medication and left .

On 01/12/22

He came again with the similar complaints  with out any history of vomiting.

No h/o fever ,cough.

Daily Routine

He daily wakes up at 6AM and  eats at 8:30AM then he go to field and have lunch at 1:00PM  and go back to field and return home by 7:00AM ,have dinner and sleep at 9:00PM.

Past history-  

No h/o diabetes,hypertension,asthma,epilepsy.

Personal history-

Diet -Mixed 

Appetite -normal

Bowel &Bladder movements -regular

Sleep -Adequate 

Occassionally alcoholic

Family history-Not significant

GENERAL EXAMINATION:

Patient is conscious,coherent and co-operative.well oriented to time,place and person.

Moderatly build and moderatly nourished.

No pallor

no cyanosis

 

No  icterus,clubbing, lymphadenopathy ,edema.

Vitals:-

BP:140/90(lft arm)

PULSE RATE:82/min

RESPIRATORY RATE:20cycles/min

TEMPARATURE:afebrile

* CNS EXAMINATION:

Right handed person 

HIGHER MENTAL FUNCTION

Counsious ,oreinted to time place person

Speech normal

Behaviour normal

Memory intact 

Intelligence normal 

CRANIAL NERVE EXAMINATION

  -OLFACTORY-normal

 - optic : normal visual field

-oculomotor,trochlear,abducens facial-intact

- vestibulocochlear- intact

 - glossopharyngeal -intact

  - vagus-intact

  -accesory spinal ganglion nerve intact

  - hypoglossal intact

Sensory system:

-fine touch: intact

-pain: normal 

-temperature  - normal

- vibration -normal

-stereognosis- normal

-two point discrimination-present

Motor system examination

Nutrition -

U/L.         R.             L

            Normal.    Normal

L/L.     Normal.       Normal

TONE:

        U/L.                     R.          L.

   

                         Normotania. Narmotonia 

         L/L 

                      Normotonia.  Normotonia 

    

POWER.   :-         RIGHT.           LEFT.

SHOULDER

flexion  :               5/5    5/5

 Extension        5/5.  5/5

Abduction     5/5.  5/5

Adduction         5/5.    5/5

Internal rotation 5/5.   5/5

External rotation    5/5.   5/5

Elbow:5/5.    5/5

Flexion.     5/5.   5/5

Extension:5/5.   5/5

Wrist:5/5.  5/5

Flexion:5/5.   5/5

Extension:5/5.   5/5

Abduction : 5/5.   5/5

adduction:5/5.   5/5

Hip

Flexion:5/5.    5/5 

Extension.  5/5.   5/5

Abduction:5/5.   5/5

Adduction 5/5.    5/5

Internal rotation:5/5.    5/5

External rotation.  5/5.    5/5

Knee 5/5.     5/5

Flexion 5/5.    5/5

Extension.   5/5.   5/5 

Ankle.  5/5.     5/5

Plantarflexion:.   5 /5.    5/5

Dorsiflexion.     5/5.  5/5

Toe.   5/5 5/5

Movements:5/5

REFLEXES: 

-Corneal present 

-Conjunctival  present 

-Abdominal: present 

-Plantar: present 

DEEP REFLEXES:

Biceps :2+

Triceps :2+

Knee :2+

Ankle:2+

CEREBELLAR 

-NYSTAGMUS absent

-DYSADEADOCHOKINESIA absent 

FINGER NOSE tip- normal

Rhomberg sign  

Rebound phenomenon present

Heel to knee intact

Gait :- normal 

Meningial sign

 Kernigs sign negative 

Brudzinski sign negetive

 

Cvs- s1 s2 heard ,no murmur,apex beat at mid clavicular line at 5 th intercoastal space.

Respiratory system 

I: Chest bilaterally symmetrical, all quadrants

moves equally with respiration

P: Trachea central, chest expansion normal

P: Resonant

A: B/l equal air entry

B/I VBS

no added sound

Per. Abdominal examination :-

I normal

P soft non tender

No organomegaly

 Provisional diagnosis-

Monocrotophos poisoning ,Headache under evalution with generalized body weakness

 Investigation- 

I would like suggest following investigations

Haemogram

Complete urine examination

RFT,LFT.

Treatment:

Optineuron

Aceclofenac

Naproxene

Zofer