A 45 YR OLD ALCOHOL-DEPENDENT PATIENT.

A 45 yr old male patient who was a constable by occupation (but he left the job one and half yr ago because of his chronic alcoholism, Irregular schedules and disturbed mind ) came to the opd on his own intention of quiting the habits of drinking alcohol and chewing tobacco, by getting admitted in the de-addiction centre here.

He has grade -2 SOB.

He has cough  associated with sputum since 10 days 

HOPI-Patient started consuming alcohol 22 yrs ago, back then he used to consume alcohol only occasionally and of a quantity of around 3 units of alcohol (once a week) and occasional chewing of tobaco.Then he along with his childhood friends started increasing the frequency of consuming alcohol from past 15 yrs and got habituated to consume alcohol daily from past 10 yrs(25 units/day) and regularly chew tobacco (10 packets/day).

Then as this routine is going on,he had conflicts with his wife 8 yrs ago and so they started living seperately (daughter staying with her mom).Since then he got addicted to alcohol even more and started to become dependent on it( eye opener +).

Patient experiences Tremors, Palpitations , fearfulness , Sleep disturbances if he doesn't consume alcohol. And experiences headache, irritability if he doesn't chew tobacco.

PAST HISTORY- He had a h/o seizure like activity (multiple episodes) since 3 yrs , associated with LOC , uprolling of eyes , frothing,tonic clonic movements.Then he used ayurvedic medicine for the same.( Last episode was 1 month back)

*h/o 2 suicide attempts thinking about being alone(drank pesticide 3yrs ago,lost his consciousness and got treated in a hospital ),since then he has on and off spasms in the ankle which relieves on walking.But currently denies any suicidal ideas.

*h/o weight loss since two months ( lost nearly 15 kgs of wt since then )

*h/o weakness in the both lower limbs since one month and 

*No h/o blood in stools or vomitus.

*No h/o pervasive low mood , suspiciousness , hearing of voices, grandiosity,over valued ideas, repetitive thoughts etc

O/E - Patient is conscious , coherent and cooperative.

Mild pallor , mild icterus , no cyanosis no koilonychia, no lymphadenopathy,no edema

CVS - s1 s2 + 

R/S - BAE + 

CNS - NAD (GCS - NORMAL)

P/A - Soft and non tender, non rigid, palpable mass in the right hypochondrium (hepatomegaly).

MSE - Pt is sitting on the chair , thin built 

ETEC + , sustained tremors -.

HIS INVESTIGATION REPORTS

ECG Interpretation - ? PAH changes 

                                    P-pulmonale

DIAGNOSIS - Patient has Alcohol Dependence Syndrome and Tobacco Dependence Syndrome with Grade - 1 Fatty Liver.

?TB 

TREATMENT - FOR ALCOHOL DEPENDENCE SYNDROME AND TOBACCO DEPENDENCE SYNDROME.

1) T.LORAZEPAM 2MG STAT

2)T.LORAZEPAM 2MG  0—0—2 ( 8PM)AND SOS

3)T.BENFOTHIAMINE 100MG  0—1—0

4)T.BACLOFEN XL 20 MG 0—0—1

5)NICOTINE GUMS 4MG 1—1 AND SOS