17-03-2025
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[17-03-2025 11.27] PPM 1: 64M in OPD right now with a neuro endocrine emergency presumably
showing choreathetosis due to striatopathy @PPM2 possibly this is very common here with many more
cases seen by us every year than you all in UK as it's essentially a marker of poor diabetes care?
[17-03-2025 13:11] PPM 1: @~PPM3 can you share the opening sugars in this patient?
Can you ask the staff to fish out his previous admission summary and email it to me?
[17-03-2025 13:14] PPM 3: his random sugar checked in casuality is 190 mg/dl sir
[17-03-2025 13:14] PPM 3: Admitted him
Shifting to Amc sir
[17-03-2025 13:15] PPM 1: Has he taken any medicine for his diabetes recently?
How do we explain his movement disorder recurrence if not due to endocrine metabolic reasons?
@PPM2
[17-03-2025 13:17] PPM 3: He seems very restless sir
He is having severe burning micturition since 5days ass with fever vomiting and loose stools, decreased
u/o
Appears dehydrated too sir
[17-03-2025 13:17] PPM 3: No sir
He is not using any meds
[17-03-2025 13:18] PPM 3: I feel he is having AKI and dyselectrolytemia too sir
[17-03-2025 13:31] PPM 1: 👍 Is the respiratory alkalosis due to his metabolic acidosis or is it the other
way around?
[17-03-2025 13:31] PPM 1: Thanks this is very important history
[17-03-2025 13:39] PPM 2: Thanks. Will need to know his full story.
[17-03-2025 13:39] PPM 2: Is he having a hypo there?
[17-03-2025 13:39] PPM 1: @~PPM3 @~PPM4 please check with the person in AMC and add him her
here
[17-03-2025 13:40] PPM 2: That's a metabolic acidosis with reasonably compensated respiratory
alkalosis
[17-03-2025 13:40] PPM 1: Hyponatremia?
[17-03-2025 13:40] PPM 2: Glycemia
[17-03-2025 13:40] PPM 2: 49?
[17-03-2025 13:40] PPM 1: 👆
[17-03-2025 13:41] PPM 2: Yes but why is the ABG showing a 49?
[17-03-2025 13:41] PPM 2: Would also like to see images of his body habitus
[17-03-2025 13:42] PPM 1: You know our ABG machines! When do use it to see anything other than
bicarbonate and CO2
[17-03-2025 13:42] PPM 1: His video is here
[17-03-2025 13:42] PPM 3: Na and glu values are too far from reality in our ABG machines sir😅
[17-03-2025 13:43] PPM 3: Ok sir
[17-03-2025 13:43] PPM 1: But we didn't do a thesis on it so there's no evidence!
[17-03-2025 13:44] PPM 2: Hmmm. Does it fit a chorea by definition? If you split the abnormal
movements into Body parts involved (B), Frequency (F), amplitude of movements (A) and timing of
the abnormal movement (T)?
[17-03-2025 13:45] PPM 2: Can your PGs describe the movement in this form?
[17-03-2025 13:45] PPM 2: I don't remember having glucose and lactate during my time there
[17-03-2025 13:46] PPM 2: And why is that? I'm sure the machines are ABL800 or something from
Abbott?
[17-03-2025 15:13] PPM 1: I guess we need to find out more about our machines from the lab
@~PPM3
Please check since when have they started giving the entire range of electrolytes and glucose in ABG
The corresponding lab sugars were 163 while glucometer was 191!
The creatinine is 2.4!
Can azotemia and acidosis be contributing to his chorea
Serum albumin is 2.8!
[17-03-2025 15:14] PPM 1: Current RBS is 146!
[17-03-2025 15:15] PPM 1: @~PPM3 also inquire if the lab lactate reports we get since last few years
are done by the same ABG machine or some other machine
[17-03-2025 15:34] PPM 1: Took the history now:
Was admitted here two years back with 500 sugars and fevers (couldn't locate the two year old file yet)
and although our team reduced his sugars and his fever subsided after 5 days he developed this
choreiform movement disorder which kept progressing after few days of hospitalization for which they
went to another hospital and got further treatment and slowly over two years the intensity of his chorea
reduced
although even before this current exacerbation six days back he actually had a slight choreiform
movement in his lower limbs!
So I guess are we dealing with a striatopathy unrelated to his metabolic syn or is this a very atypical
metabolic striatopathy?
There's no family history of similar movement disorder.
[17-03-2025 15:40] PPM 3: Okay sir
[17-03-2025 16.49] PPM 1: One of our PGs discovered this video of his taken presumably on 2023 march! 👇
I had to crop it but it also showed prominent "jack in the box" tongue!
[17-03-2025 16.50] PPM 1: @~PPM4 @~PPM5 would it be possible to prompt the
premium chat gpt with this video to answer @PPM2's question?
[18-03-2025 10.07] PPM 5: Don't need premium.. even free can analyze videos. However it just
converts to individual frames and analyzes images, get transcript etc. not quite the video analysis of the
human eye yet :-)
PPM 1 -👍
[19-03-2025 09.51] PPM 1: Morning ward update on day before yesterday's chorea patient
[19-03-2025 09.55] PPM 1: This time his chorea appears to have been exacerbated by sepsis! @PPM2
[19-03-2025] PPM 2: 👍
[19-03-2025 09.59] PPM 1: No hyperglycemia at all this time! @~~PPM5 @~PPM3 talk
about causes and effects. We are overloaded with these unusualities every day!
[19-03-2025 10:40] CR: Hospital name is seen on the bedsheets. Is it okay to upload the video?
[19-03-2025 10:52] PPM 1: Can.
[19-03-2025 10:54] CR: Okay
[19-03-2025 10:57] PPM 1: Sometimes we can even try to edit institutional names at a later date
@PPM2 @~PPM5 by hiring editing experts?
[19-03-2025 11:02] PPM 5: AI can easily remove the names from images.. let me check for videos.
PPM 1 - 👍
[19-03-2025 16:38] PPM 2: Sydenham? 🫣
[19-03-2025 16:50] PPM 1: At this age would be very rare!
[19-03-2025 16:54] PPM 1: Although again these guys from Germany reported the impossible! 👇
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