CASE SUMMARY

Brief Description of illness :

It started on September 2016 when the patient had a problem of Insomnia and
Pulse Problem (AVNRT) and had 3 minor seizures at an interval of one hour. The
patient then admitted to Sahara Hospital, Lucknow under Dr Abhishek Shrivastava
(Neuro-Physician) and was diagnosed “Septic Encephalitis”. The patient treated
well and was relieved, and medications were started as follows :-

1) Etilaam 0.25 mg (BD)

2) Quitipine 25 mg (BD)
3) Dilzem 180 (OD)

It worked for almost a year and then again in 2017, the patient had a difficulty in
moving his hands, going to toilet, speech problem. Then a visit to Dr Abhishek
Shrivastava (Neuro-Physician) diagnosed that he has “Parkinsons” disease also.
Thereafter, in addition to the above medicines, one more medicine (name below)
started.

4) Syndopa 110 (Half TDS)

It again worked for almost a year, but the patient had swelling under his eyes and
in his feet.

Now, from 21st July 2018, the patient had a problem of Bloating Stomach. The
patient was taken to the Physician (Dr Sameer Gupta) and was advised an
Ultrasound as well as Pathological Tests namely Anti HCV, HBSAG, Serum Protein,
Serum Albumin, and the results of the same are attached. Ultrasound stated that
the patient has SPLEENOMEGALLY WITH DIALTED PV SYSTEM AND ACSITIS ?
CHRONIC LIVER DISEASE. Dr Sameer Gupta advised the medicine Dytor Plus (OD)
and also asked to visit Neuro-Physician.

The patient further gone for second opinion at SGPGIMS Lucknow with Patient
Record Number 2018673760 under Dr Amit Goyal. He advised UGIE and some
tests which are safe in Patient’s Login and Dr Goyal advised the patient to continue
Dytor Plus and review after 2 weeks (14th August 2018).
On visiting Dr Abhishek Shrivastava (Neuro-Physician) on 3rd August 2018, he
reduced the medicines and the final medicines are shown now as below :-

1) Etilaam 0.25 mg (Half BD)

2) Quitipine 25 mg (Half BD)
 3) Dilzem 180 (OD)
4) Syndopa 110 – STOPPED
5) Dytor Plus (OD)

After around 2 days, the patient slowly lost his consciousness and after having a
telephonically conversation with Dr Abhishek Shrivastava (Neuro-Physician), he
stopped all his related medicines and stated that it is a case of Gastro Enterology
now.

After few days, the patient unconsciously taken to the SGPGI OPD on 7 th August
2018. Dr Arjun saw the patient and advised for some pathological tests and entered
the Patient’s Name for ADMISSION. The patient waited for 2-3 days for Call of Dr
Arjun for ADMISSION but never received a call. Since then, the patient was unable
to pass stool and urine. The Patient’s condition was worsening.

On 9th August 2018, the patient visited Dr Puneet Mehrotra, Gastro Enterology and
he advised XRay of Abdomen, Serum Sodium, Serum Potassium, Blood Ammonia
tests. In the Test Reports, Ammonia found on higher side (130). Dr Mehrotra
advised the following medicines.

1) Ampicillin 500 (2 tabs TDS)

2) Hepamerz Sachet (1 TDS)
3) Rifagut 550 (1 BD) for a day and then advised for Blood Ammonia test again.

Then the Blood Ammonia went down to 75 and the patient felt slightly better.
Then he continued the medicines for 5 days.

From 3rd day onwards, the patient again got unconscious and stiffness in body.
Then Dr Mehrotra advised to urgently admit the patient under any Gastro
Enterologist or Neurologist. Thereafter, the patient was admitted to Charak
Hospital on 13th August 2018 under the treatment of Dr Ankur Singh (Gastro
Enterologist). At present, the patient is in ICU since then and he is not showing any
improvement.