General Data

D.A.V., 24 y/o, Male, Single, Catholic,

Unemployed, born on April 19, 1991 in
Quezon City, presently residing at
Block 29 Lot 18 Verde Heights
Subdivision San Jose Del Monte
Bulacan, admitted for the 3rd time at
FEU-NRMF Medical Center on August
12, 2015

Chief Complaint

BODY WEAKNESS

Interval History
This is a known case of Caustic
Ingestion
with
Severe
Erosive
Esophagitis
Status
Post
Esophagogastroduodenoscopy
Status
Post
Laparoscopic
tube
Jejunostomy Insertion

 1 month PTA, he experienced body

weakness with decrease in grip strength
and weight loss as evidenced by loosening
of clothes.
There was no change in his daily activities.
No associated signs and symptoms such as
fever, vomiting, diarrhea, facial asymmetry,
slurred speech and paralysis.
No medications were taken. No consult was
done.

 1 week PTA, he collapsed while walking due

to the progression of body weakness.
No loss of consciousness reported.
Activities of daily living with assistance
He also had moderate grade fever of 39
degree Celsius, chills and episodes of
difficulty of breathing.
Sponge bath was done to relieve the fever.
No medications were taken. No consult was
done.

 Few hours PTA, he could no longer

walk nor stand up.
He was brought to FEU-NRMF Medical
Center ER for consult.
Laboratory Examination showed low
Potassium level, hence admitted.

Past Medical History

(+) chicken pox, measles and mumps
Immunizations were unrecalled
March 2015: admitted at FEU-NRMF
Medical Center due to ingestion of
TUFF toilet cleanser. (+) Auditory
Hallucinations.
July 2015: admitted at FEU-NRMF
Medical Center due to vomiting for
13 days.
(+) allergy to seafoods

Family History
Father: deceased at 72 due to
Pneumonia
Mother:
58
years
old
with
Hypertension
He was the 2nd among 3 siblings.
Eldest:
Male,
30
years
old,
apparently well
Youngest: Male, 20 years old,
apparently well
No family history of DM and cancer

Personal and Social History

1 year vocational course in Mechanics.
Food preferences include chicken, vegetables and fish.
Use of illicit drugs such as Marijuana 4 days a week
(paraphernalia: 1 stick/rolling paper or use of bong) and
Methamphetamine 3 sessions per day for a week
Alcoholic beverage drinker (3 bottles of beer 3x a week) since
2011.
Started smoking 10 sticks per day last year but quit last March
2014.
Difficulty sleeping at night with 5 hours of sleep/day.
He lives with his parents and siblings in a bungalow type of
house that has 1 window and is well-ventilated.
source of water is from Nawasa.
Waste is collected twice a week.

Review of Systems
(+) weight loss of 26 kilograms since
March 2015

Physical Exam
Jejunostomy tube at the right lower
quadrant

DIFFERENTIAL DIAGNOSIS

Ischemic Stroke
characterized by the sudden loss of
blood circulation to an area of the
brain, typically in a vascular
territory,
resulting
in
a
corresponding loss of neurologic
function.

RULE IN
Body weakness
(gradual onset)
Cigarette smoker
Illicit drug use
Alcohol beverage
drinker

RULE OUT
Sudden onset
(-) Neurological
deficits (monocular or
binocular visual loss,
visual field deficits,
diplopia, dysarthria,
facial asymmetry,
ataxia, paralysis)

Collapsed 2x, 1
week PTA

(-)Cardiac arrhythmias

Dehydration
occurs when water intake is less than
water loss
Common causes of dehydration
include vigorous exercise, especially
in hot weather; intense diarrhea;
vomiting;
fever
or
excessive
sweating

RULE IN
Vomiting 2x, 1
week PTA
One episode of
moderate grade

RULE OUT
(-)Signs of
dehydration like dry
mouth,
lightheadedness,
muscle cramps, and
palpitations

fever (39C)
Body weakness

(-) reduced urine

output and
darkening of the
urine

Anemia
Anemia is caused by either a decrease
in
production
ofred blood cellsor
hemoglobin, or an increase in loss
(usually due to bleeding) or destruction
of red blood cells
Men, hemoglobin level of less than
13.5 gram/100 ml
Women, hemoglobin of less than 12.0
gram/100 ml.

RULE IN
RULE OUT
Body weakness (-) Tachycardia,
dyspnea, angina
severe erosive
esophagitis (5
Normal capillary
mos ago)
refill time
Jejunostomy
tube at RLQ
(duodenum, (primary
site for iron absorption)
is bypassed)

Hypokalemia

 Defined as plasma K concentration of

<3.5 mM
Can be caused by redistribution of K
between tissues and ECF or by renal
and non-renal loss of K

Clinical features
Can have adverse effects on cardiac
rhythym, blood pressure and
cardiovascular morbidity
Has prominent effects on cardiac,
skeletal and intestinal muscle cells
ECG changes broad flat T waves, ST
depression, QT prolongation
Effects on kidney NA,Cl, HCO3
retention, polyuria, phosphaturia,
ammoniagenesis

PATHOPHYSIOLOGY

MANAGEMENT

 Lab
Serum Mg

 Adequate nutrition

 K+ repletion
Mild to moderate (3-3.5 meq/l): oral KCl
at 60-80 meq/day
Severe (<3 meq/l): rapidly
40-60 meq raises 1-1.5 meq/l
135-160meq raises 2.5-3.5 meq/l
IV KCl 20-40 meq K+ added to each liter of
dextrose or saline at a rate of 10-20 meq/h

Decrease Na intake

THANK YOU!