Dr.Rana Saqlain Shoukat

Dr.Rana Saqlain Shoukat Doctor .Writer .Medical student .MBBS(MD)

๐Ÿ“‹ EMERGENCY CASE PRESENTATIONโ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”๐Ÿง‘โ€โš•๏ธ HISTORYโ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”๐Ÿ”น 48-year-old male๐Ÿ”น Chronic alcoholic๐Ÿ”น Brou...
02/06/2026

๐Ÿ“‹ EMERGENCY CASE PRESENTATION
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐Ÿง‘โ€โš•๏ธ HISTORY
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐Ÿ”น 48-year-old male
๐Ÿ”น Chronic alcoholic
๐Ÿ”น Brought to emergency department
๐Ÿ”น Acute presentation

๐Ÿ” EXAMINATION
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐Ÿ”ธ Delirium (acute confusional state)
๐Ÿ”ธ GCS 12 โ€” reduced consciousness
๐Ÿ”ธ Ataxia โ€” cerebellar/gait dysfunction
๐Ÿ”ธ Bilateral ophthalmoplegia โ€” extraocular muscle palsy

๐Ÿงช INVESTIGATIONS TO CONSIDER
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐Ÿ”ฌ Serum thiamine levels
๐Ÿ”ฌ Blood glucose (โš ๏ธ do NOT give glucose first!)
๐Ÿ”ฌ LFTs, ammonia level
๐Ÿ”ฌ FBC, electrolytes, magnesium
๐Ÿ”ฌ CT brain (to exclude bleed)
๐Ÿ”ฌ ABG
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”

โ“ What is the MOST LIKELY diagnosis and IMMEDIATE treatment?

A) Alcoholic cerebellar degeneration โ€” thiamine oral
B) Wernicke's encephalopathy โ€” IV thiamine (Pabrinex) 500 mg TDS before any glucose
C) Delirium tremens โ€” IV lorazepam + haloperidol
D) Hepatic encephalopathy โ€” lactulose + rifaximin
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐Ÿ’ฌ Drop your answer below! ๐Ÿ‘‡๐Ÿฝ
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”

LOW TESTOSTERONE: Signs You Shouldnโ€™t IgnoreShare this post to spread awareness and help others recognize the signs. ...
02/06/2026

LOW TESTOSTERONE: Signs You Shouldnโ€™t Ignore

Share this post to spread awareness and help others recognize the signs.

Atorvastatin side-effects and management โฌ‡๏ธ
02/06/2026

Atorvastatin side-effects and management โฌ‡๏ธ

โš•๏ธ Clinical Vignette โ€“ Endocrinology & Pharmacologyโ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•๐Ÿฉบ HISTORY๐Ÿ”น 30-year-old woman๐Ÿ”น Post-partum โ€” 5 week...
30/05/2026

โš•๏ธ Clinical Vignette โ€“ Endocrinology & Pharmacology
โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•
๐Ÿฉบ HISTORY
๐Ÿ”น 30-year-old woman
๐Ÿ”น Post-partum โ€” 5 weeks
๐Ÿ”น Fever & rigors
๐Ÿ”น Sore throat
๐Ÿ”น Known case of thyrotoxicosis
๐Ÿ”น On Carbimazole since first trimester
โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•
๐Ÿ” EXAMINATION
๐Ÿ”น Acutely unwell / septic appearance
๐Ÿ”น Fever (hyperpyrexia)
๐Ÿ”น Throat โ€” inflamed / tonsillar involvement
๐Ÿ”น No localising signs of infection beyond oropharynx
โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•
๐Ÿงช INVESTIGATIONS
๐Ÿ”น WBC: 0.8 ร— 10โน/L โฌ‡๏ธ (severely low)
๐Ÿ”น Neutrophils: 0.1 ร— 10โน/L โฌ‡๏ธ (profound agranulocytosis)
๐Ÿ”น Blood cultures โ€” pending
๐Ÿ”น TFTs โ€” (thyroid function to be reviewed)
๐Ÿ”น CRP / ESR โ€” elevated
โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•
โ“ What is the most critical immediate action?

A) Increase carbimazole dose
B) Stop carbimazole immediately, admit to reverse isolation, take blood cultures, start broad-spectrum IV antibiotics, give G-CSF, notify endocrinology
C) Give prednisolone only
D) Restart propylthiouracil
โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•โ€•

๐Ÿง  ๐—–๐—Ÿ๐—œ๐—ก๐—œ๐—–๐—”๐—Ÿ ๐—–๐—”๐—ฆ๐—˜โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”๐Ÿ‘ฉ A 40-year-old woman presents with a lifelong bleeding tendency. Her father had prolonged...
30/05/2026

๐Ÿง  ๐—–๐—Ÿ๐—œ๐—ก๐—œ๐—–๐—”๐—Ÿ ๐—–๐—”๐—ฆ๐—˜
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐Ÿ‘ฉ A 40-year-old woman presents with a lifelong bleeding tendency. Her father had prolonged bleeding after a tooth extraction.
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐Ÿ“‹ ๐—›๐—œ๐—ฆ๐—ง๐—ข๐—ฅ๐—ฌ
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐ŸŸฃ Easy bruising โ€” spontaneous and recurrent
๐Ÿ”ด Menorrhagia โ€” heavy, prolonged menstrual bleeding
๐Ÿ’ฌ Father had prolonged post-extraction bleeding
๐Ÿ“… Symptoms suggest a lifelong, inherited condition
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐Ÿ”Ž ๐—˜๐—ซ๐—”๐— ๐—œ๐—ก๐—”๐—ง๐—œ๐—ข๐—ก
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐Ÿฉน Mucocutaneous bleeding pattern
๐Ÿšบ No haemarthrosis or deep muscle bleeds
๐Ÿ‘จโ€๐Ÿ‘ฉโ€๐Ÿ‘ง Family history consistent with autosomal inheritance
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐Ÿงช ๐—œ๐—ก๐—ฉ๐—˜๐—ฆ๐—ง๐—œ๐—š๐—”๐—ง๐—œ๐—ข๐—ก๐—ฆ
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐ŸŸข Platelet count โ€” ๐—ก๐—ผ๐—ฟ๐—บ๐—ฎ๐—น
๐Ÿ”ด Bleeding time โ€” ๐—ฃ๐—ฟ๐—ผ๐—น๐—ผ๐—ป๐—ด๐—ฒ๐—ฑ โฑ๏ธ (15 min)
๐ŸŸข PT โ€” ๐—ก๐—ผ๐—ฟ๐—บ๐—ฎ๐—น
๐Ÿ”ด APTT โ€” ๐—ฃ๐—ฟ๐—ผ๐—น๐—ผ๐—ป๐—ด๐—ฒ๐—ฑ โฑ๏ธ (50 sec)
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
โ“ ๐—ช๐—›๐—”๐—ง ๐—œ๐—ฆ ๐—ง๐—›๐—˜ ๐——๐—œ๐—”๐—š๐—ก๐—ข๐—ฆ๐—œ๐—ฆ?
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐—”) Haemophilia B
๐—•) Factor XI deficiency
๐—–) Von Willebrand disease (vWD)
๐——) Glanzmann's thrombasthenia
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”
๐Ÿ’ฌ Drop your answer below! Answer reveal coming soon ๐Ÿ‘‡
โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”โ”

Follow my page
26/05/2026

Follow my page

Follow me Everyone
26/05/2026

Follow me Everyone

Follow my page Everyone
26/05/2026

Follow my page Everyone

Follow my page Everyone
23/05/2026

Follow my page Everyone


Acute Respiratory Distress syndrome
23/05/2026

Acute Respiratory Distress syndrome

Address

Lahore

Website

Alerts

Be the first to know and let us send you an email when Dr.Rana Saqlain Shoukat posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Shortcuts

Share

Category