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 11-12mL/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 after

consumption of open stocks

• 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)