CLINICAL HISTORY: Date and time of Interview: July 24, 2013 Date of Admission: IDENTIFYING DATA: Name: C. .

Address: %am&an!, 'C A!e: 32 y.o. (eli!ion: (oman Cat)oli* "e#: $emale Nationality: $ili&ino Civil "tatus: %arried "our*e Information: atient (elia+ility of "our*e: ,-. C)ief Com&laint: Generalized body weakness HISTORY OF RESENT ILLNESS: 1 day /A, &atient e#&erien*ed sudden onset of undo*umented fever asso*iated wit) +ody malaise, nausea and vomitin! 1 e&isode. 0omitus amounted to a+out 3 ta+les&oon
1 day /A, sudden onset of undo*umented )i!) !rade fever asso*iated wit) +ody malaise, nausea and vomitin! #1. 0omitus amounted to a+out 3 ta+les&oon *onsistin! of mu*ous only. 123 A+dominal &ain, 123 sore t)roat, 123 )eada*)e. %ana!ed wit) 4ioflu and Al+edon wit) relief. 5ours /A, u&on wa6in! u&, e#&erien*ed num+ness w)i*) started on t)e u&&er e#tremities and t)en &ro!ressed to t)e lower e#tremities. 173 dys&nea, 173 di88iness, 173)eada*)e *)ara*teri8ed as t)ro++in! wit) s*ale of ,910, 173 &al&itations and &alor. atient t)en lost *ons*iousness and was immediately +rou!)t to 8*m*.

AST !EDICAL HISTORY: atient )ad no &revious )os&itali8ations nor sur!eries. 5e also )as no 6nown aller!ies to any food or dru!s. FA!ILY HISTORY: 1 73Ast)ma: maternal 1 2 3Can*er 1 2 3Cardia* diseases ERSONAL AND SOCIAL HISTORY: 1 2 3Dia+etes %ellitus 1 735y&ertension 1 2 3%ental Illness

Sara"an# Aldilyn $% AD&'(SO! le)el III $*ly +,# -.,+

Cardia1: 123&al&itations Gas3ro(In3es3inal: 123 loss of a&&etite. Nose and sinuses: 123 nasal stuffiness. 123 dri++lin!. 123 dou+le vision. s6in is warm and moist. Ne*rolo5i1: 123 tin!lin!. 123 it*)in!. HEENT: Head: t)e s6ull is normo*e&)ali*9atraumati* 1NC9A/3. 123 &ain u&on defe*ation. Sara"an# Aldilyn $% AD&'(SO! le)el III $*ly +. 173 )oarseness Ne1k: 173 anterior &ain. res&onsive. RE/IE0 OF SYSTE!S: General S*r)ey: No noted re*ent wei!)t loss. !*s1*loskele3al: 123 <oint stiffness. He6a3olo5i1: 123 easy +leedin!. &ete*)iae. 2 No ras). 123 vomitin!.. Eyes: 123 +lurrin! of vision. 123 dys&)a!ia. 123 &ain. Geni3o( 'rinary: 123 dysuria. /i3al Si5ns: /em&erature 1a#illary3 > 3. 123 num+ness. 123 ras)es. 123 eye &ain.atient is a . 173 dis*omfort. Ears: 123 )earin! loss. 2 Nails wit)out *lu++in! or *yanosis. 123 <oint &ain. or e**)ymoses. Res2ira3ory: 173 &ain on t)e ri!)t side of t)e *)est radiatin! to t)e sternum and at t)e +a*6. HEENT: Head: 173 )eada*)e. 123 &olyuria eri24eral /as1*lar: 123 le! *ram&s. 123 nausea. 123 li!)t)eadedness.2 * (( > ?0+&m 5( > 112+&m Skin: 2 Color is !ood. 5is two si+lin!s are a!ed . *oo&erative +ut wea62 loo6in!. 5e is fond of &layin! outside t)eir )ouse wit) t)eir nei!)+ors wit)out any su&ervision. 123 )ematuria. Skin: 123 it*)in!. 5e is in res&iratory distress and on =2 mas6 and I0 line. 123 &olydi&sia HYSICAL E7A!INATION: General A22earan1e: atient seen lyin! on t)e +ed awa6e. 123 )y&o!astri* &ain.# -. 123 di88iness. 123 dis*omfort. 123 *onsti&ation. 123 &ain. Mouth and throat: 123 lum&s.rade 1 student and is t)e eldest of 3 si+lin!s.+ .. Endo1rine: 123 )eat and *old intoleran*e. 5air wit) avera!e te#ture distri+ution.and 3 years old res&e*tively.

Abdo6en: 2 Inspection: A+domen is flat 2 Auscultation: Normoa*tive +owel sounds. 2 A+le to &erform full ran!e of motion. No mass. *lear +reat) sounds at Ceft lun! field. T4ora8 and l*n5s: 2 Inspection: /)ora# symmetri* wit)out de*rease e#&ansion. E83re6i3ies: 2 Darm to tou*). eAually round and rea*tive to li!)t and a**ommodations. diffi*ulty of +reat)in!.. 2 $ull and eAual &eri&)eral &ulses. &in6 *on<un*tiva.Percussion: Dullness at ri!)t lun! field 2 Auscultation: De*rease +reat) sounds at (i!)t Cun! field. No s&leenome!aly and 6idneys not felt. . Neck :/ra*)ea is in midline. 2 (e!ular rate and r)yt)m. se&tum midline: no sinus tenderness Throat (or Mouth): =ral mu*osa &in6. tenderness at ri!)t anterior *)est. 2 Percussion: Civer s&an is ?*m %CC.Eyes: @ni*teri* s*lera. )i!)2!rade fever of 3.. de*rease ta*tile fremitus at ri!)t lun! .+ . +ody malaise 9F: /a*)y&nea wit) (( of ?0 *&m. 123 ron*)i. dis* mar!ins s)ar&: no )emorr)a!es or e#udates. Lymph NodesBNo *ervi*al lym&) nodes.# -. 2 Ca&illary refill of E2 se*onds CLINICAL I! RESSION: edia3ri1 Co66*ni3y A19*ired ne*6onia Ca3e5ory C SALIENT FEAT'RES: 5istory: $ever. 123 rales. e#amination of (i!)t lun! field revealed de*reased ta*tile fremitus. 2 Palpation: "moot) liver ed!e and not &al&a+le on t)e ri!)t *ostal mar!in. &)aryn# wit)out e#udates.Palpation: /enderness at ri!)t anterior *)est. dullness and de*reased +reat) sounds DIFFERENTIAL DIAGNOSES: Sara"an# Aldilyn $% AD&'(SO! le)el III $*ly +. "oft and non2tender: no or!anome!aly or masses &al&ated. No visi+le lesions or masses. /%s *lear Nose: Nasal mu*osa &in6. 123 w)ee8in! Cardia1: 2 No murmurs or e#tra sounds. &rodu*tive *ou!). Ears: A*uity not diminis)ed to w)is&ered voi*e: inta*t to s&o6en voi*e.2 C.

a &oorly understood disorder w)i*) may o**ur s&ontaneously or as t)e result of autosomal dominant in)eritan*e. +ut unli6e &atients w)o are truly &otassium de&leted. A*ute 4ron*)itis 3. Ast)ma ARACLINICALS: !ANAGE!ENT: /)ere are several ty&es of eriodi* aralysis asso*iated wit) meta+oli* and ele*trolyte a+normalities.000 .Di::eren3ial 1. Atta*6s may +e &rovo6ed +y stress su*) as a viral illness or fati!ue. 5emot)ora# 4. 5 may o**ur s&oradi*ally in t)e form of $amilial 5y&o6almi* aralysis 1$5 3. es&e*ially +etween e&isodes w)en no *lini*ally dete*ta+le wea6ness is &resent. /)is form of eriodi* aralysis is felt to +e t)e result of disordered *ellular &otassium re!ulation &er)a&s due to sodium or *al*ium *)annel a+normalities. tendon refle#es may +e de*reased or a+sent +ut sensation is !enerally inta*t. Fle*tro*ardio!ra&)i* *)an!es are *ommon.+ . =f t)ese. transient wea6ness to severe disa+ility resultin! in life2t)reatenin! res&iratory failure. insulin or steroids. As t)is is &rimarily a &ro+lem wit) mus*le *ontra*tion rat)er t)an nerve *ondu*tion. 5 o**urs in several settin!s and t)e dia!nosis may reAuire an e#tensive sear*) for t)e underlyin! etiolo!y sin*e t)e treatment varies a**ordin! to t)e *ause. Fle*tromyo!ra&)y reveals a+normalities in some &atients +ut is often normal. ot)er ele*trolytes are usually normal. A &ertur+ation of sodium and *al*ium ion *)annels results in low &otassium levels and mus*le dysfun*tion. %utations of t)e A NA!" and " N#A !enes )ave +een identified t)at *ause a+normalities in sodium *)annels resultin! in a+normal Sara"an# Aldilyn $% AD&'(SO! le)el III $*ly +. 5y&o6alemi* eriodi* aralysis 15 3 is t)e most *ommon wit) a &revalen*e of 1 in 100.# -. Alt)ou!) t)e serum &otassium level is often alarmin!ly low. or *ertain medi*ations su*) as +eta2a!onists. t)e *)an!es do not *orrelate well wit) t)e measured serum level. /)e *lini*al features of t)e syndrome vary somew)at de&endin! on t)e underlyin! etiolo!y +ut t)e most stri6in! feature is t)e sudden onset of wea6ness ran!in! in severity from mild. leural Fffusion R*le in R*le O*3 2.. total +ody &otassium is a*tually normal wit) t)e *)an!e in t)e serum level refle*tin! a s)ift of &otassium into *ells. Indeed.

. es&e*ially t)ose wit) no )istory or eviden*e of ot)er diseases and no si!nifi*ant ris6 fa*tors for stro6e.+ . Sara"an# Aldilyn $% AD&'(SO! le)el III $*ly +.t)is ty&e of &aralysis is ty&i*al for 5 . /)e &aralysis resolved *om&letely followin! &otassium re&la*ement eriodi* aralysis is im&ortant to *onsider w)en seein! a &atient wit) sudden onset wea6ness or &aralysis. +ut ra&id *orre*tion of &otassium a+normalities *an resolve t)e sym&toms Aui*6ly and *om&letely.# -. "&ironola*tone and a*eta8olamide )ave +een used for &ro&)yla#is wit) some su**ess alt)ou!) lon!2term &otassium su&&lementation may +e ne*essary /)is &atient &resented wit) sudden onset &aralysis and sin*e t)e we still do not 6now t)e serum &otassium of t)e &atient. $ailure to &ro&erly dia!nose and treat eriodi* aralysis *an +e fatal. A*ute &aralyti* e&isodes are treated wit) &otassium re&la*ement and *lose monitorin! of t)e *ardia* r)yt)m and serum &otassium levels.&otassium ion flu#. assumin! t)at it is mar6edly a+normal &otassium.

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