A 44-year-old male with Crohn's disease diagnosed 15 years before, who was admitted to the General Surgery Department due to abdominal pain and diarrhea for a week, compatible with a sprout of his disease.
In home treatment with corticoids and tapering, the patient has had an ileostomy for two years after performing a subtotal colectomy, with a rectal stump closed as a result of a sprout of his disease
Previously he had undergone several resective operations such as removal of the last 40 centimeters of ileum, ileocecal valve and blind, after an ileocecal perforation, as well as other interventions for anal fistula with abscess in his glue.
During the current admission, a polymicrobial perianal infection resistant to medical antibiotic treatment is subjected to a surgical intervention in which an amputation is performed by resecting it rectally.
Postoperative course was uneventful until on the tenth day she suffered a generalized tonic-clonic seizure lasting 3 minutes without sphincter incontinence.
A general biochemistry was performed, highlighting an albumin-corrected calcium of 8.42 mg/dl (rn: 8.7-10.6), K 2.6 mg/dl (rn: 3.6-5.2), sodium reference values of 4-4.9 and albumin
A cranial CAT scan showed no abnormalities.
The patient presented an electrocardiogram on the day of admission, with normal sinus rhythm at 79 bpm, without QT or PR prolongation.
Two days later, the patient developed a tonic-clonic seizure, which lasted one minute.
After being assessed by the Neurology Department, an electroencephalogram was performed, which showed no pathological findings. The patient was treated with propranolol.
Persistent seizure of the same characteristics despite medical treatment, a 24-hour electroencephalographic record is made in which no alterations are evident.
Since the patient presents signs of Cushings disease and malnutrition, as well as decreased intake and asthenia, they consult the Nutrition Unit for nutritional support assessment if necessary.
In the directed interview, the patient complained of paresthesia in the lower limbs, which she recently perceived more as intense pruritus, without other symptoms.
He also reported that he had presented three seizures of similar characteristics to the current ones for 5 months, without further clinical repercussions, consulting on one occasion in the Emergency Department, where the first seizure episode was treated.
On physical examination the patient weighs 55.1 kg and height 172 cm (BMI 18.63 kg/m2).
suffers a loss of 7 kg of weight in the last 6 months which supposes a rate of weight loss/time of 15.23%, which implies a severe malnutrition.
The physical examination showed a cutaneous manifestation of mild mucose and a moderate decrease in fat and muscle mass, which was later diagnosed as mixed protein-energy malnutrition of moderate degree, according to the classic anthropometric and nutritional parameters.
The rest of the physical examination was normal, with no clinical signs of hypocalcemia or hypomagnesemia such as Troseau's sign, Chovstek's sign, muscle spasms, tremor, or hyporeflexia.
The dietary history of the months prior to admission revealed an insufficient caloric intake for their needs, which was also deficient in certain food groups such as dairy products, fruits, vegetables and red meat.
Malaise with negative fluid balance due to high ileostomy output, low blood electrolyte levels begin treatment monitored parenterally and other volume replacement,
Previously a blood extraction was carried out to determine the above mentioned pathologies when a possible deficit was suspected.
That same day the patient suffered a seizure similar to previous ones.
The analysis showed magnesium of 0.76 mg/dl (rn: 2.40-5.40) with phosphorus, calcium, potassium and sodium within the reference values.
An infusion with high doses of magnesium sulfate was prescribed with the progressive normalization of its blood levels, being sufficient for maintenance treatment the supply of high doses of oral magnesium lactate as maintenance treatment.
After stabilizing the figures with oral intake, the antiepileptic medication is withdrawn, with no further episodes of seizures appearing.
