Transcript COURSE IN THE WARD

COURSE IN THE WARD
Day of admission (Oct. 21, 2010)
• Patient was placed on NPO; vital signs were monitored
q1h (including pupillary light reflex) and fluid input and
output
• Patient was given IVF D5/MB 500mL to run at 1112mL/hr
• CBC with platelet revealed anemia with Hgb 106 g/L and
Hct 0.32
• Blood chemistry showed low creatinine 0.22 mg/dL and
Na of 136 mEq/L; K and total Ca were normal
Day of admission (Oct. 21, 2010)
• Blood CS was negative for growth
• CSF analysis showed no growth on culture and sensitivity; Gram
stain was negative for growth; high CHON and normal sugar levels
The following drugs were given:
• Phenobarbital 85 mg/SIVP over 30 mins (loading dose) was given
then 12mg/SIVP over q12h, 12hrs after the loading dose
• Meropenem 120 mg/IV infusion over 30mins q8h (40 mg/kg/dose)
• Gentamycin 12 mg/SIVP OD (4mg/kg/day)
• Dexamethasone 0.6 mg/SIVP q6h for 2 days only
• Diazepam 1.2 mg/SIVP for seizure >5 mins
Day of admission (Oct. 21, 2010)
• Referral to Pediatric Neurology (Diagnosis:
Seizure disorder, etiology to be determined)
• MRI with contrast showed normal findings
1st HD (Oct. 22, 2010)
• Patient had seizures for which phenytoin 65
mg/IV infusion for 30 mins (15.3 mg/kg/dose)
was given as loading dose then 11 mg/IV
infusion for 30 mins q12h after
2nd - 4th HD (Oct. 23-25, 2010)
• No episodes of seizure
5th HD (Oct. 26, 2010)
Recurrence of seizure with upward rolling of eyes and
stiffening of extremities for which the ff drugs were
given:
• IV phenytoin was shifted to oral 125 mg/5mL, 0.5
mL q12h
• Phenobarbital grain ½ 30 mg/tab ½ tab ODHS
MRI showed normal findings
5th HD (Oct. 26, 2010)
• d/c meropenem and gentamycin
consumption of open stocks
after
• Recurrence of seizures almost every hour (1-3
mins/episode)
• O2 per face mask at 51ppm was given
• Phenobarbital 12 mg/SIVP after 12 hrs and
phenytoin 11 mg/SIVP q12hrs were given
6th HD (Oct. 27, 2010)
• Still with seizure episodes
• Phenobarbital load of 46 mg/SIVP was given and was
maintained at 12 mg/SIVP after 12 hrs
• Serum phenobarbital and phenytoin revealed
elevated phenobarbital of 31.66 and low phenytoin
of 1.20; high-sensitive CRP was normal
8th HD (Oct. 29, 2010)
• Phenytoin was given at 8mg/SIVP per infusion
and phenobarbital dose was maintained
• Topiramate 25 mg/tab divided into 10 pptabs was
given OD
• Pyridoxine 50 mg/tab was also started
• EEG was deferred
11th HD (Nov. 1, 2010)
• Still with seizure episodes
The ff. medications were given:
• Pyridoxine 50 mg/tab BID
• Topiramate 25 mg/tab divided to 5 pptabs, 1
pptab BID
• Phenytoin 10 mg/SIVP
• Phenobarbital 12 mg/SIVP
• Diazepam 1.2 mg/SIVP for active seizures
• Ketoconazole shampoo 3x/week
13th HD (Nov. 3, 2010)
The ff. drugs were given:
• Phenytoin 125 mg/5 mL 0.4 mL q4h
• Phenobarbital 30 mg/tab divided into 10
pptabs to be given 4 pptabs q12h on oral form
14th HD (Nov. 4, 2010)
• 21 channel EEG was done
The rest of the hospital stay was unremarkable.
Date of discharge (Nov. 6, 2010)
Take home medications:
• Topiramate 25 mg/tab 1 tab divided into 5
pptabs then give 1 pptab BID
• Phenytoin 125 mg/5 mL, 0.4 mL TID
• Phenobarbital grain 1 (60 mg/tab) 1 tab
divided into 6 pptabs, 1 pptab q12h
• Pyridoxine 50 mg/tab 1 tab AM, 2 tabs PM
(total dose 150 mg)
Date of discharge (Nov. 6, 2010)
Special instructions:
• To have standby O2 tank at home
• Seizure precautions at all times
Follow-up or Transfer Instructions:
• Follow-up at Pedia SBC on Nov. 13, 2010, 8AM
• Follow-up after 2 wks at Pedia-Neuro OPD on
Nov. 23, 2010 at 2PM (to bring results of EEG)