Status epilepticus
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uprolling of eyes present
Loss of consciousness present
Involuntary micturition present
Past history :
Loss of consciousness present
Involuntary micturition present
Past history :
At the age of 7 years 1st episode of seizures had started and taken to hospital and used Eptoin 3 tab for 5 years.
At the age of 18 years she got married to her relative who is chronic alcoholic and always argues with her .after 3 months of marriage seizures had started again ,taken to hospital, used epsolin tab continously upto 2012 .during this period she had 1/2 episodes per month with a gap of 2/3 months with no episodes at all.
In 2012, she started having 10 to 15 episodes per month and stopped medications started using homeopathic, ayurvedic,naatu vaidyam for a month.but seizures were not stopped so she was taken to hospital and relieved .
From 2012 to until now she was using Tab.levipil(500 mg ), Tab.Sodium Valproate(200mg), Tab.clobazem(10mg)
Not a k/c/o DM,HTN,TB,Asthma.
No h/o fever,loosestools,dysuria ,headache,blurring of vision.
Patient stays at home,appetite was normal, mixed diet,bowel and bladder movements are normal, no addictions.
Menstrual history: age of menarche:13 y,
At the age of 18 years she got married to her relative who is chronic alcoholic and always argues with her .after 3 months of marriage seizures had started again ,taken to hospital, used epsolin tab continously upto 2012 .during this period she had 1/2 episodes per month with a gap of 2/3 months with no episodes at all.
In 2012, she started having 10 to 15 episodes per month and stopped medications started using homeopathic, ayurvedic,naatu vaidyam for a month.but seizures were not stopped so she was taken to hospital and relieved .
From 2012 to until now she was using Tab.levipil(500 mg ), Tab.Sodium Valproate(200mg), Tab.clobazem(10mg)
Not a k/c/o DM,HTN,TB,Asthma.
No h/o fever,loosestools,dysuria ,headache,blurring of vision.
Patient stays at home,appetite was normal, mixed diet,bowel and bladder movements are normal, no addictions.
Menstrual history: age of menarche:13 y,
3 days/28 days
O/E : E1V1M5
Cvs: S1 and S2 heard
RS : BLAE +
P/A - soft ,non tender
CNS:
Patient unconscious
Right. Left
Tone : UL. Hypertonia. Hyperotonia
LL. Hypertonia Hypertonia
Power:UL. 3/5 3/5
LL 3/5. 3/5
Reflexes :
Biceps. - -
Triceps. - -
Supinator. - -
Knee. - -
Ankle. - -
Finger nose in co ordination - no
Knee heel in co ordination - no
Remaining tests are not elicited.
Provisional Diagnosis:Status epilepticus
Treatment:
DAY 1:
Morning:
1.INJ.LORA 4 MG IV STAT IF SEIZURE EPISODES.
2.INJ.PHENYTOIN 1 GM IV STAT IN 100 ML NS
3.INJ.VALPROATE 1500 MG IV STAT
4.INJ NEOMAL 1 GM IV SOS IF TEMP> 101 F
5.INJ.PAN 40 MG IV OD
6.INJ.PHENYTOIN 15 AMPULES IN 100 ML NS @ 50 MG/ML.
Patient is intubated and on mechanical ventilator.
Fever spikes present .
Evening:
1.INJ.LORA 800MG IV STAT
2.INJ.VALPROATE 800 MG IV STAT
3.RT feeding tube with milk and protein powder 2nd hourly.
4 Rest same treatment.
DAY 2:
Patient is on ventilator ,no seizures.
ACMV to CPAP
FiO2 -35
PEEP -6
E1 VT M5
Fever spikes, GRBS -116 mg/dl.
1.INJ.PHENYTOIN 150 MG IV TID
2.INJ.LEVIPIL 1000 MG IV BD
3.INJ.MIDAZOLAM @ 20 ML/HR
decrease infusion rate @1 ml/ hr.
4.RT FEEDS 200 ML 2ND HOURLY [MILK + PROTEIN POWDER +WATER ]
5.INJ.PAN 40 MG BD
6.IVF NS @ 50 ML / HR( continuous infusion).
7.INJ NEOMAL 1 GM IV SOS IF TEMP> 101 F
DAY 3 :
Patient on ventilator, no seizures
CPAP
FiO2 -50
PEEP -6
E1 VT M5
Fever spikes present
1.INJ.MONOCEF 1HM IV BD
2.INJ PHENYTOIN 150 MG IV TID
3.INJ.LEVIPIL 1000 MG IV BD
4.INJ.MIDAZOLAM@ 4ML/ HR decrease infusion rate 1 ml/hr
5.RT FEEDS 200 ML 2ND HOURLY
6.INJ.PAN 40 MG BD
7.IVF NS @ 50 ML/HR (continuous infusion)
8.INJ NEOMAL 1 GM IV SOS IF TEMP> 101 F
DAY 4 :
Patient is on ventilator
CPAP
FiO2 -100
PEEP -6
E1 VT M5
Fever spikes present
GRBS :148 mg/dl
1.INJ.MONOCEF 1HM IV BD
2.INJ PHENYTOIN 150 MG IV TID
3.INJ.LEVIPIL 1000 MG IV BD
4.TAB.AZEE 500.MG OD
5.RT FEEDS 200 ML 2ND HOURLY
6.INJ.PAN 40 MG BD
7.IVF NS @ 75 ML/HR (continuous infusion)
8.TAB.MET -XL 12.5 MG OD
9.Nebulization mucomist 6th hourly.
10.INJ NEOMAL 1 GM IV SOS IF TEMP> 101 F.
Evening
Patient is on T- piece
No seizures, fever spikes present
PEEP -6
FiO2 - 30
E4 M5 VT
SpO2 - 93 %
DAY 5:
Patient on T- piece
E3 VT M4
SpO2 -95%
Fever spikes present, GRBS - 159 mg/dl
CNS :
Right. Left
Tone UL. Hypertonia Hypertonia
LL. Hypertonia Hypertonia
Power UL 1/5. 1/5
LL. 1/5. 1/5
1.INJ.MONOCEF 1HM IV BD
2.INJ PHENYTOIN 150 MG IV TID
3.INJ.LEVIPIL 1000 MG IV BD
4.TAB.AZEE 500.MG OD
5.RT FEEDS 200 ML 2ND HOURLY
6.INJ.PAN 40 MG BD
7.IVF NS @ 75 ML/HR (continuous infusion)
8.TAB.MET -XL 12.5 MG OD
9.Nebulization mucomist 6th hourly.
10.INJ.PCM 1GM IV TID
11.TAB.ENCORTE CHRONO 500 MG OD
O/E : E1V1M5
General examination :
No pallor. No icterus,cyanosis,clubbing ,lymphadenopathy.
Cvs: S1 and S2 heard
RS : BLAE +
P/A - soft ,non tender
CNS:
Patient unconscious
Right. Left
Tone : UL. Hypertonia. Hyperotonia
LL. Hypertonia Hypertonia
Power:UL. 3/5 3/5
LL 3/5. 3/5
Reflexes :
Biceps. - -
Triceps. - -
Supinator. - -
Knee. - -
Ankle. - -
Finger nose in co ordination - no
Knee heel in co ordination - no
Remaining tests are not elicited.
Provisional Diagnosis:Status epilepticus
Treatment:
DAY 1:
Morning:
1.INJ.LORA 4 MG IV STAT IF SEIZURE EPISODES.
2.INJ.PHENYTOIN 1 GM IV STAT IN 100 ML NS
3.INJ.VALPROATE 1500 MG IV STAT
4.INJ NEOMAL 1 GM IV SOS IF TEMP> 101 F
5.INJ.PAN 40 MG IV OD
6.INJ.PHENYTOIN 15 AMPULES IN 100 ML NS @ 50 MG/ML.
Patient is intubated and on mechanical ventilator.
Fever spikes present .
Evening:
1.INJ.LORA 800MG IV STAT
2.INJ.VALPROATE 800 MG IV STAT
3.RT feeding tube with milk and protein powder 2nd hourly.
4 Rest same treatment.
DAY 2:
Patient is on ventilator ,no seizures.
ACMV to CPAP
FiO2 -35
PEEP -6
E1 VT M5
Fever spikes, GRBS -116 mg/dl.
1.INJ.PHENYTOIN 150 MG IV TID
2.INJ.LEVIPIL 1000 MG IV BD
3.INJ.MIDAZOLAM @ 20 ML/HR
decrease infusion rate @1 ml/ hr.
4.RT FEEDS 200 ML 2ND HOURLY [MILK + PROTEIN POWDER +WATER ]
5.INJ.PAN 40 MG BD
6.IVF NS @ 50 ML / HR( continuous infusion).
7.INJ NEOMAL 1 GM IV SOS IF TEMP> 101 F
DAY 3 :
Patient on ventilator, no seizures
CPAP
FiO2 -50
PEEP -6
E1 VT M5
Fever spikes present
1.INJ.MONOCEF 1HM IV BD
2.INJ PHENYTOIN 150 MG IV TID
3.INJ.LEVIPIL 1000 MG IV BD
4.INJ.MIDAZOLAM@ 4ML/ HR decrease infusion rate 1 ml/hr
5.RT FEEDS 200 ML 2ND HOURLY
6.INJ.PAN 40 MG BD
7.IVF NS @ 50 ML/HR (continuous infusion)
8.INJ NEOMAL 1 GM IV SOS IF TEMP> 101 F
DAY 4 :
Patient is on ventilator
CPAP
FiO2 -100
PEEP -6
E1 VT M5
Fever spikes present
GRBS :148 mg/dl
1.INJ.MONOCEF 1HM IV BD
2.INJ PHENYTOIN 150 MG IV TID
3.INJ.LEVIPIL 1000 MG IV BD
4.TAB.AZEE 500.MG OD
5.RT FEEDS 200 ML 2ND HOURLY
6.INJ.PAN 40 MG BD
7.IVF NS @ 75 ML/HR (continuous infusion)
8.TAB.MET -XL 12.5 MG OD
9.Nebulization mucomist 6th hourly.
10.INJ NEOMAL 1 GM IV SOS IF TEMP> 101 F.
Evening
Patient is on T- piece
No seizures, fever spikes present
PEEP -6
FiO2 - 30
E4 M5 VT
SpO2 - 93 %
Same treatment
DAY 5:
Patient on T- piece
E3 VT M4
SpO2 -95%
Fever spikes present, GRBS - 159 mg/dl
CNS :
Right. Left
Tone UL. Hypertonia Hypertonia
LL. Hypertonia Hypertonia
Power UL 1/5. 1/5
LL. 1/5. 1/5
1.INJ.MONOCEF 1HM IV BD
2.INJ PHENYTOIN 150 MG IV TID
3.INJ.LEVIPIL 1000 MG IV BD
4.TAB.AZEE 500.MG OD
5.RT FEEDS 200 ML 2ND HOURLY
6.INJ.PAN 40 MG BD
7.IVF NS @ 75 ML/HR (continuous infusion)
8.TAB.MET -XL 12.5 MG OD
9.Nebulization mucomist 6th hourly.
10.INJ.PCM 1GM IV TID
11.TAB.ENCORTE CHRONO 500 MG OD
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