Clinical Cases

A Case of Acute Hypotension with Influenza

Written by Rajiv Peres

Dr. Rajiv Peres shares a case of acute hypotension with influenza in a man of 52. Chill with continuous desire for warmth, particularly that of the sun, was one of the symptoms leading to the simillimum. 

 

Abstract: This is a case of a 52-year-old male who suddenly emerged with acute hypotension at his workplace. It is about how keen observation by his subordinate who is the treating physician contributed to artistic homoeopathic prescribing.

The interesting aspect is the rediscovery of the PQRS modality from source books retrospectively. This acute case highlights how rapidly a circulatory remedy like Conium Maculatum can restore normal blood pressure. The future of homoeopathic science lies safe in the hands of such artistic homoeopaths who treat acutes with competency and ease.

A man of  52 years, homeopath by profession, professor teaching in a college arrived from his home town M.P on 16th January 2023 in a lovely grey suit, looking as if he is a groom with black dye on beard and head.

On the morning of the 18th he was feeling unwell after overeating (Paratha’s). He was constipated and while straining he had fainting along with much exhaustion, burning and weakness such that he nearly fell down inside the bathroom.

He felt as if he would get a heart attack. The weakness lasted for 30 min and after that he recovered and could stand up and report to work. One month ago, he had a similar episode of syncope in his bedroom and his son came to his rescue.

In the last month the problem of haemorrhoids with minor bleeding has cropped up. He was frightened after seeing a few drops of blood in the commode. Then giddiness came. He has slowed down since last one month (vasovagal syncope).

On 20th January 2023 in the morning, he looked very exhausted and told me, (who is his subordinate) that he is feeling extremely chilly (coldness felt in joints) and wants to be in the sun and desires to sleep the entire day.

He even expressed his desire to lie down on a bed in the hot sun. He had not passed his stools this morning and was feeling very uncomfortable. He was unable to sleep the previous night and went to bed at 4am. Since the time he has come from his hometown he is unable to do intellectual work related to departmental planning.

By nature, he has his own fixed ways, very stiff, upright posture always while walking or sitting and doesn’t agree and doesn’t listen. Speaks his own opinions. At lunch he was afraid to eat oily and spicy food, he did not eat rice. He said that he is not having proper taste and feels better if he doesn’t eat. He just ate 3 theplas (Gujrati bread) home-made due to insistence of our principal.

He did not drink any water. Since was looking very sick that afternoon I advised him to lie down on the hospital bed for just 2 hours. After 45 minutes he walked inside the department saying that its already 5pm. I informed him that it was just 3.30pm.

He was hot to touch and feverish. I inquired why he woke up so early. He said that he was afraid that I would forget to call him and that he might remain behind in the work place. He was wanting to sit in the sun but had become so weak that he was walking unsteady like a drunkard.

I helped him lift his chair and directed it toward the sun. He sat there and placed a stool before him and kept his legs over it. By 4pm he was grunting and tilting sideways on his chair. Luckily my table was just next to him so he kept his hand on it and neck and head also tilted.

I got alerted and stopped my work and ran to fetch for a sphygmanometer B.P=90/50mmHg. If spoken to he was arousable but then would slip off again immediately. He only asked for coffee. I observed his face was red due to sitting in the sun. Sweat under the left eye and his legs were falling off the stool.

He was literally hanging downing from the chair. I saw watery coryza dripping down from his nostril. He would wipe it off with his white towel. When other staff tried to inquire about his condition, he was unable express his symptoms.

I got very frightened and informed other teachers from the medicine department not to leave him alone. From morning we saw chill and afternoon to evening we observed heat followed by sweat but thirstless throughout the day. No history of smoking nor alcohol consumption in his entire life (To exclude CVS involvement).

His bleeding was in drops before and after stool. No blood streak to the stool. No protrusion of mass per rectum (hence it is internal haemorrhoid lesion). His blood chemistry showed no deviation from normal (lipid profile, ECG-normal.)

Probable clinical diagnosis: Hypotension (B.P=90/50, confusion, upset stomach, fainting, shallow breathing) with Influenza (cough, fever, weakness, running/stuffy nose, sore throat, aches & pains, headache, sneezing, no taste).

I ran to the library and referred to the BBCR chapter general modalities: Sun ameliorated heat and light. Pg1145. We have a choice between Anacardium, Conium, Platina, Strontium-carb

I referred to Boger’s synoptic key. Under Conium; In Bold letters PROGRESSIVE DEBILITY, suddenly sick and weak. Faints at stool. Sweat under eyes. Modality; letting parts hang down (limbs and head from the chair). Pg178

I ran and gave him Conium Maculatum 30, 1 single dose.

Reasons for Conium (Boericke’s Materia Medica– difficult gait, better fasting, worse from taking cold, worse from physical or mental exertion). Pg203-204

H.C Allen keynotes– No inclination for business or study. Domineering. Pg 92

Even though sick, wears beautiful clothes. Circulatory medicine. First rectum relaxed, not working, then taste relaxed, not working, then stomach relaxed, not eating, not drinking, then muscles relaxed (ataxia) difficulty to walk. Wanted to be alone. Although he was sick, he was completely aware of which faculty came to see him even in that drowsy state.

Follow up in 15 mins on 20th January 2023:  He felt some wakefulness, his expressions returned. He was able to stand, thanked everyone. I dropped him to his relative’s home who is a doctor. Advised plenty of fluid intake.

Follow up 21st January morning: he looked once again charming person, no feeling of chilliness in the morning nor entire day. BP=120/70mmHg checked at 9.30am. He was surprised because normally his blood pressure is 110/70mmHg.

He rejoiced and said that his SPO2 has improved from 94% checked on 19th January to 98% checked on 20th January evening. No fever. 20th Night woke up at 2am. Later could sleep. No other medicines consumed neither allopathic nor any home medicines. At 4.45pm B.P=110/60mmHg.

Follow up 23rd January Morning: Passed normal stool, not fainting. Conducted clinical session for students. Flu nearly resolved. Previous day travelled to Temples in 4-wheeler yet good energy. Slept much better than other days. B.P=100/60mmHg at 4.30pm.

Follow up  25th January: Did not pass stool in the morning. Worried about his constipation. Felt good energy in the morning, slept well and refreshed. Feeling dissatisfied as had eaten papaya, apples and chicos yet no stool. Also walked for about an hour previous day. B.P=120/70 at 12noon. Same evening after returning from work he passed stools without any difficulty, same night again another stool without straining.

Follow Up on 26th January: Passed normal stool in the morning. Felt happy and relaxed but shabbily dressed for republic day (psoric expression). Went to restaurant for lunch. Cautious to avoid spicy foods.

Follow up on 28th January: Resumed his morning exercises and cooking practices. Able to focus on work like never before. Sleep very refreshing and less fearful of his health but avoids wife’s call because he is tired of telling her that he is alright.

Follow up on 13th February 2023: Sleep refreshing. B.P=120/70mmHg. Conducted exams and marked papers. Attended to patients, cooking for himself. Preparing for sports day 16th February.

Follow Up on 28th February 2023: No constipation. B.P=120/70mmHg. Participated in badminton, ran 400 metres relay race on 16th February. No constipation. Appetite good. Eating fearlessly. Sleep refreshing.

Follow Up 27th March 2023: No constipation. B.P=120/70mmHg. No attack of fainting. No bleeding during stool. Appetite eats with everyone even spicy things. Sleep refreshing. Peak performance at workplace. Managing everything tactfully.

Learning: In acute disease the art of physician is to perceive the symptoms present at the moment. Specially perceive those symptoms which are away from the pathology should be considered in totality on the basis of uncommon and persistent modality according to aphorism 153, which in this case was Sun ameliorates. Although BBCR repertory has this rubric, I could not trace this modality in Boger’s synoptic key nor in William Boericke’s Materia Medica nor in H.C Allen’s Keynotes. Hence, I resorted to searching into source books.

In Materia Medica Pura Hahnemann writes in Conium: “Chilliness so he must always remain in the sun” Hering’s guiding symptoms mentions ‘Chill, with continuous desire for warmth, particularly that of the sun’. Clarke’s Dictionary of Materia Medica “Chilliness, with desire for heat, es.p in the sunshine”. This characteristic modality guided me to prescribe Conium and this is called the art of homoeopathic prescribing.

Listen to your patient for he is telling you the diagnosis. In this case the patient was speaking through his actions. Keeping legs on stool is the leg raising position given to hypotension cases as part of first aid measure.

This case demonstrates the rapid, gentle cure in shortest possible time on easily comprehensible principles promised in aphorism 2 of Organon of Medicine.

About the author

Rajiv Peres

Dr. Rajiv Rui Viegas Peres M.D(Hom) Assistant Professor, Dept of Organon of Medicine, Aarihant Homoeopathic Medical College, Bhoyan Rathod, Gandhinagar, Gujarat. Pin 382721 Received Best Teacher’s Award 2010-11, Received Hahnemann Award 2018, Received Excellence in Homoeopathy Award in April 2022, Active Member of H.E.R.I Mumbai.

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