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What Causes Shivering Of Hands, Inability To Speak And Weight Loss?

Posted on Fri, 4 Sep 2015

Question: Suffered from acute typhoid in childhood, now 75 and then from TB 10 years back. Otherwise normal but her hands sp. shivering from beginning. suddenly unable to speak 3 weeks back, hospitalized and then regained, released but same thing. weight has reduced much. Please avoid Inj. prescription. Prescribe medicines that can run as Respected Doc you may like. Suffered from Jaundice also in 1990. I am watching my mother in law from 1986-always liking to lie down in the bed, best if for 24 hours but not sleeping-always complaining no sleep. Pl prescribe .

Answered by Dr. Tushar Kanti Biswas (3 hours later)

Brief Answer:
TIA and insomnia -elderly patient

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
It seems that your mother in-law had suffered transient ischemic attack(TIA) in the form of transient difficulty in speaking and as also CT sacn brain showed no change except cerebral parenchymal loss/cerebral atrophy(age-related).
Her lack of sleep or insomnia is age-related.
Age-related changes in sleep consist of a shortening of the successive
sleep stages (especially the deepest stage 4), giving rise to an instability of the sleep structure, frequent nocturnal wakening and earliness of morning wakening.
Treatment is Zolpidem Tartrate prescribed for short-term treatment of insomnia. For elderly : An initial 5 mg dose is recommended. Maximum dose: Do not exceed 10 mg. However it is a prescription drug.You need to get from a registered medical practitioner only.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Tushar Kanti Biswas (57 minutes later)

Respected Doctor, Please suggest a brand name for Zolpidem tartrate and We shall be grateful to you.

Due regards,

Answered by Dr. Tushar Kanti Biswas (2 hours later)

Brief Answer:
Zolpidem tartrate

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

Zolpidem tartrate is available in various brand names.Commonly prescribed: Tablet NITREST.Tablet ZOLFRESH.You are unlikely to get any of these tablets without a prescription from a registered medical practitioner bearing his registration number. Dose and frequency is to be decided by a doctor in an individual case.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Tushar Kanti Biswas (35 hours later)

Respected Doctor, Zolpidem Tartrate--you have mentioned as a short term treatment. Please tell for what span at maximum this can be continued. I must confess that patient is responding nice just by a day. Thank you Doctor Thank you very much.

REGARDS ALWAYS,

XXXXXXX XXXXXXX

Answered by Dr. Tushar Kanti Biswas (3 hours later)

Brief Answer:
Zolpidem Tartrate-duration of treatment

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

Zolpidem Tartrate, a benzodiazepine-receptor agonist is to be used nightly or intermittent basis. It is most effective and well-tolerated class of medications .
Zolpidem Tartrate has half-lives of 2–3 h-hence gives near natural sleep approximately 6 hours and has no significant hang-over.
However with even brief continuous use of benzodiazepine-receptor agonists, rebound insomnia can occur upon discontinuation. The likelihood of rebound insomnia and tolerance can be minimized by short durations of treatment, intermittent use, or gradual tapering of the dose.

Hence this drug for sleep should be used as and when required basis.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Tushar Kanti Biswas (45 hours later)

Respected Dr As the patient continually complained from years back about dizziness, acid and wind-two medicines were also being given along with nitrate 5 till yesterday--Betavert and Rantac. BP now--86 / 53 mm of Hg and pulse--85. Please Suggest.
OUR REGARDS,

Answered by Dr. Tushar Kanti Biswas (3 hours later)

Brief Answer:
Elderly patient and co-morbidities

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

Betavert (Betahistine) is given for Meniere's disease and that too should not be given for indefinite period . Liquid sucralfate is better than rantac (ranitidine) because in long-term it reduces the natural gastric acid barrier also interferes with absorption of iron,Vit B12 apart from various drug interactions.Low BP has many causes and a doctor needs to examine her before prescribing any drug.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Tushar Kanti Biswas (3 days later)

Respected Dr. It's true patient is bed ridden-also true hardly opening the eyes for the last couple of days-but taking a glass of Horlicks at a time--Nitrest 5 and Sucralfate liquid are the only medicines and strongly believe these two have kept her--my request to you Dr. She requires a boosting up which I am a layman and you know all. BP has not been measured again but she is taking 4-5 spoonfuls of salt & sugar water everyday for the last 3 days. Bowels clear and as usual. We are all looking at you.

Answered by Dr. Tushar Kanti Biswas (33 minutes later)

Brief Answer:
Elderly patient-vegetative sate

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
Get her BP measured again. Get her serum electrolytes,BUN & serum creatinine done to rule out any metabolic cause of her drowsiness. Sleeping pill is to be given intermittently as and when required, not on a regular basis.
Multivitamin supplements can also be added.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj