50 year old man with involuntary movements of all four limbs, generalised weakness

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        CASE DISCUSSION

50 yr old man was brought to the casualty with c/o generalised  weakness and involuntary movements of all four limbs

HOPI

Patient had been consuming alcohol (whiskey) since 25 years ,  usually consumes whiskey ( around 60 to 90 ml ) daily after coming home from farming work
Gradually increased drinking roughly around 90 to 180 ml , sometimes used to go to work after consuming alcohol and later he used to consume 360 ml daily
And he got covid in 2020 ,became weak and was abstinent during that time , post covid he felt weak and was consuming upto 180 ml daily
He had a similar episode once when he consumed alcohol daily for 15 days , but didn't consume any food and then stopped for 20 days , consumed food and experienced tremors which slowly subsided but didn't seek any medical attention
Patient experiences tremors if he doesn't consume alcohol

2  years ago  he was diagnosed with diabetes type 2 ( he had fever and was revealed to be diabetic after tests ) and took medication for a month and stopped after that

1 year ago he had developed inguinal hernia and had underwent hernioplasty surgery and was abstinent for 7 months and stayed home for recovery
Since one month started to go to work and felt weak and used to consume alcohol(180ml) after coming home and sleeps well ,
Since 10 days  Patient stopped going to work , used to consume alcohol 250ml everyday morning to evening and didn't consume any food and had decreased sleep  and stopped consuming alcohol but didn't consume any food and developed tremors when he stopped alcohol , 2 days later he suddenly showed cramping of both upper limbs and lower limbs with increased tremors , profuse sweating , chest pain , apparently he also had deviation of mouth to the left side and the family immediately rushed him to RMP and was then told to go to hospital

Past history :

Similar episode in the past but less severe which eventually subsided with out any medication 

K/c/o diabetes type 2 since 2 years ,not on any medication now 

N/k/c/o HTN ,TB, asthma, CVA, CAD