Bogalech Tadesse is 18 yrs old female client presented with muscle tremor, confusion, epigastric pain, sever diaphoresis. Shewas well and performing NDA before 5 hrs.

Question

History of past illness
Two years back she was admitted in ewa hospital for severe malaria.
Personal history
She sometimes drinks alcohol for last five years but she did not have habit of chewing chat.
Social and family History
She is notmarried but have boyfriend and living with her family. Both parents are alive. Her parents live in rural area.
Review of systems
HEENT: has headache, no blurred vision
lGS: no swelling and enlargement
Respiratory: no cough and she has shortness of breath
CV: palpitation
GIT: have nausea, vomiting, loss of appetite, epigastric pain
GUS: NAD
MSS: involuntary movement of both lower and upper extremities
Skin: dry oral mucosa
CNS: irritable and confused
Discussion Questions
2. Rearrange the possible hypothesized problems (Defend why? Why not?)

Answer 1

Based on the clinical presentation and history of Bogalech Tadesse, we can hypothesize several possible problems. The symptoms described, like muscle tremors, confusion, severe diaphoresis, nausea, vomiting, and epigastric pain, suggest a variety of possible medical issues. Here’s how we can categorize and rearrange these potential problems based on priority, considering the most life-threatening and urgent conditions first:

Possible Problems and Reordering:

1. Hypoglycemia (Low Blood Sugar)

   • Defense: The acute onset of confusion, muscle tremors, diaphoresis, nausea, and vomiting, especially after not eating (assuming NDA means not having eaten recently), strongly suggests hypoglycemia. This condition requires immediate attention to prevent severe neurological damage.

2. Acute Stress Reaction or Alcohol Withdrawal Syndrome

   • Defense: Given her history of alcohol consumption and the onset of confusion, tremors, and other autonomic symptoms (diaphoresis, palpitations), alcohol withdrawal should be considered. This aspect may not be immediate but is a secondary concern once hypoglycemia is ruled out or treated.

3. Electrolyte Imbalance (e.g., Hypokalemia)

   • Defense: Symptoms like muscle weakness, confusion, and gastrointestinal distress (nausea/vomiting) can be associated with electrolyte imbalances. These could potentially complicate a diagnosis of hypoglycemia or withdrawal, and thus monitoring would be crucial.

4. Malaria or Other Infections

   • Defense: Given her history of severe malaria two years ago, while it might be rare for malaria to recur without re-exposure, it is a possibility to rule out infectious diseases, especially considering her acute symptoms and epigastric pain.

5. Anxiety or Panic Attack

   • Defense: The combination of physical symptoms (palpitations, tremors) with the social context can also suggest a panic attack, especially if there is any psychological stress in her environment (like living with family and having a boyfriend). However, this would likely not explain the significant physical symptoms as primary drivers.

6. Gastrointestinal Issues (e.g., Gastritis, Pancreatitis)

   • Defense: Given her epigastric pain, loss of appetite, and vomiting, there may be a gastrointestinal disturbance. Yet, it is critical to address more acute, systemic issues like hypoglycemia before attributing her symptoms predominantly to GI causes.

Summary of Reordering:

1. Hypoglycemia
2. Acute Stress Reaction or Alcohol Withdrawal Syndrome
3. Electrolyte Imbalance
4. Malaria or Other Infections
5. Anxiety or Panic Attack
6. Gastrointestinal Issues

Conclusion:

The potential causes of Bogalech's symptoms have been ordered based on their likelihood of being acute and life-threatening, and the need for immediate intervention. Hypoglycemia takes precedence due to the proven ability to induce confusion and seizures if untreated, followed by conditions arising from her social and personal background. Further assessment would be necessary to confirm the diagnosis, including blood tests to check glucose, electrolytes, and any potential infections.