NEUROLOGY

CASE REPORT-
HIPOKALEMIA & HIPOCALCEMIA
IDENTITY
 Name : Mr. B K
 Age : 44 years old
 Address: Gang Buntu, Jelambar
 CURRENT MEDICAL HISTORY
Chief of complaint : weakness and tingling in both legs since 2 days
Patient present with complaints of weakness and tingling in both legs since 2 days,
continuously throughout the day. Pain and numbness are denied. Complaints worsened until now
the hands also feel weak but not tingling. Patient also complain of nausea and vomiting since
the last 2 days and are getting worse. The patient will vomit at every meal or drink. The
patient's body looks pale and yellow and is the first time experienced by the patient. Fever,
stomach ache, and diarrhea are denied. Patient often consumes fast foods or street foods than
home-cooked meals. History of nausea or vomiting when eating fatty foods is denied.
PAST MEDICAL HISTORY
 No history of diabetes mellitus
 No history of heart disease
 No history of hypertension
 No history of dyslipidemia
PHYSICAL EXAMINATION
GCS E4V5M6
VITAL SIGNS
Blood pressure 160/101 mmHg
Heart Rate 109x/minute, regular, sufficient
RR 20x/minute
Temperature 36,8℃
SpO2 99%
Weight 82kg
Height 170cm
BMI 28,37 (obese)
PHYSICAL EXAMINATION

Head Normochepali, hair: black, even distribution

Pupil: round, equal, Ø 3mm/3mm, palpebral edema (-/-), anemic

Eyes
conjunctiva(-/-), Icteric sclera (+/+), lagophthalmus(-/-), ptosis(-/-),

Ears Normal shape, battle’s sign (-/-), otorrhea (-/-), blood (-/-)

Nose Septum deviation (-), secrete (-/-), blood (-/-)

Mouth Mucose: wet, hyperemic (-), teeth in normal range

Neck Tracheal deviation (-), no lymph node enlargement

PHYSICAL EXAMINATION
Inspection Simetrical, both sides are even in static and dynamic state,

Thorax – Palpation No palpable mass, no crepitation

Pulmo Percussion Sonor on both lungs

Auscultation Vesicullar (+/+), rales (-/-), wheezing (-/-)

Inspection Ictus cordis pulsation not seen

Palpation Ictus cordis pulsation palpable on ICS V MCLS

Cor • Right heart margin : ICS III - V linea parasternalis dextra

Percussion • Left heart margin : ICS V, 1 cm at medial line MCLS
• Upper heart margin : ICS III linea parasternalis sinistra
Auscultation S1 and S2 heart sound in normal range, murmur (-), gallop (-)
PHYSICAL EXAMINATION

Inspection Flat on inspection, wound (-), mass (-)

Auscultation Rigid (-), bowel sounds (+) 5x/minute

Abdomen Muscular defence (-), epigastric pain (+), no liver
Palpation
or spleen enlargement palpated

Percussion Tympanic on all abdomen region

Extremities All extremities warm, CRT < 2sec, edema (-/-)

Skin Skin turgor in normal range, icteric (+), cyanosis (-)

NEUROLOGICAL EXAMINATION
MENINGEAL SIGNS
Neck stifness (-)
Brudzinsky I (-)
Brudzinsky II (-)
Brudzinsky III (-)
Brudzinsky IV (-)
Laseq (+)
Kernig (-)
NEUROLOGICAL EXAMINATION
CRANIAL NERVE

N. I No examinations was performed

N. II No examinations was performed

Ocular movements In normal range In normal range

Ptosis - -
N. III
Pupil size 2mm 2mm
N. IV
Pupil shape Round, equal Round, equal
N. VI
Direct Light Reflex + +

Indirect Light Reflex + +

 NEUROLOGICAL EXAMINATION
Right Left
Ophthalmic sensibility Normal Normal
Maxillar sensibility Normal Normal
Mandibular sensibility Symmetric Symmetric
N. V
Masseter and temporal
muscle contraction + +

Corneal reflex + +
Palpebral fissure ±2 mm ±2 mm
Frontal contraction Round, equal Round, equal

N. VII Lagophthalmus - -
Grinning Normal Normal
Cheek inflation - -
 Opening mouth +
N. V Moving the jaw +
Biting +
Facial Expression Symmetric
Palpebrae Fissure Symmetric
Raised Eyebrows Symmetric
N. VII
Wrink Forehead Symmetric
Lagophtalmus - -
Grinning Symmetric
Puff Cheeks Symmetric
N. VIII Ability of hearing +/+

Sound Quality Normal

N. IX
Swallowing +
N. X
Pharynx, Uvula +
M. Sternocleidomastoideus +
N. XI
M. Trapezius +

N. XII Tounge Tremor -

NEUROLOGICAL EXAMINATION
PHYSIOLOGIC REFLEX
Right Left
Biceps ++ ++
Triceps ++ ++
Patella ++ ++
Achilles ++ ++
PATHOLOGICAL REFLEX
Hoffman - tromner - -
Babinski - -
Chaddock - -
Schaefer - -
Gordon - -
Oppenheim - -
NEUROLOGICAL EXAMINATION
MOTORIC NERVE
Right Left
Strength 5555 5555
5555 5555
Tonus Normotony, fascilutation on both tight
Trophy Normotrophy
Sensoric Touch Normal Normal
Nerve Pain - -
Diagnosa : hypokalemia, hypocalcemia
 WD/
1. Quadriparesis ec susp electrolite imbalance
 DD/ GBS, Myelitis
2. Icteric, vomitus ec susp hepatitis, cholelitiasis
3. Hypertension
Diagnosis
• Vomiting-induced hypokalemia and
hypocalcemia
Planning
 Lab test
 Hepatitis panel

 USG abdomen
PEMERIKSAAN 5/12 7/12 8/12 9/12 10/12 11/12 SATUAN NILAI RUJUKAN

Hemoglobin 11,6 12,2 g/dl 14.0-18.0

LED 59 56 mm/jam 2-30
Leukosit 9,3 8,4 103/uL 5.0-10.0
Basofil 0 0 % 0-1
Eosinofil 2 3 % 1-3
Segmen 81 77 % 50-70
Limfosit 13 14 % 21-40
Monosit 4 6 % 2-8
MCV 81 83 82 – 92
MCH 28 28 pg 26 – 32
MCHC 35 34 g/dl 31 – 36
Hematokrit 33,3 36,2 Vol % 37.0-47.0
Eritrosit 4,13 4,34 106/uL 4.00-5.00
Trombosit 441 455 103/uL 150-450
Ureum 8 mg/dl 15-39
Cretatinin 1,12 Mg/dl 0,80-1,30
PEMERIKSAAN 02/12 07/12 08/12 09/12 10/12 11/12 SATUAN NILAI RUJUKAN
GDS 112 mg/dl 70-180
Kalium 1,95 2,62 2,27 3,26 3,05 3,53 Mmol/l 3,50-5,10
Natrium 133 141 137 Mmol/l 137-145
Klorida 84 Mmol/l 98-107
Calcium total 8,40 6,80 7,80 mg/dl 8,5-10,10
Magnesium 1,7 1,9 1,8 mg/dl 1,8-2,4
Gamma GT 50 U/L 15-73
LDH 737 U/L <480
SGOT 337 271 u/l 15 – 38
SGPT 193 176 u/l 12 – 78
HBs Ag Non reaktif
Anti HAV IgM Negatif
Anti HCV total Negatif
TSH 3,09 uiU/ml 0,38-4,31
Albumin 3,3 g/dl 3,4-5,0
Asam urat 4,0 mg/dl 3,5-7,2
 PEMERIKSAAN URINALISA 09/12 SATUAN NILAI RUJUKAN
Warna Kuning agak keruh Kuning jernih
BJ 1.010 1.000-1.030
PH 8 5-8,5
Protein +1 Negatif
Glukosa Negatif Negatif
Keton urin Negatif Negatif
Bilirubin Negatif Negatif
Darah samar +1 Negatif
Nitrit Negatif Negatif
Urobilinogen 0,2 0,1-1
Leukosit +1 Negatif
Sedimen urin
Leukosit 4-6 /LPB 0-3
Eritrosit 6-8 /LPB 0-2
Silinder Negatif Negatif
Epitel Positif 1+
Bakteri Negatif Negatif
Kristal Negatif -
Lain-lain Negatif -
USG abdomen
 Mild splenomegaly
 Morfology of liver and gall bladder are normal
 No cholelithiasis or cholecystitis
 Other intra-abdominal organs are visualized in the normal range
 TREATMENTS
Maganol (paracetamol) 3x1 Analgetik,antipyretic
Provelyn (pregabalin) 3x75mg Anticonvulsant
Vometa (Domperidone) 3x1 Peripheral selective D2 & D3
receptor antagonist
Mucosta (Rebamipide) 3x1 Mucoprotectant
Hepamax (lecithin, silymarin pjytosome, schizandra extract) 3x1 Suplements for liver

KCl 6x15meq
NaCl caps 3x500mg
MgSO4 20% (extra) 6cc
Ca gluconas (extra) 1 amp
Minophagen (glycyrrhizic acid) 1x3amp Hepatic protectors
Interco (mecobalamin) 3x1 amp Vitamin B12
Thank you