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, low RBC 3.34, MCV 94.80, MCH 31.90, MCHC 33.60, RDW 14.30, MPV 9.20, platelet 302, WBC 8.30, low neutrophil 0.25, segmenter 0.25, lymphocyte 0.65, monocyte 0.03 and eosinophil 0.07

Day of admission (Oct. 22, 2010) Blood chemistry showed low creatinine 0.22 mg/dL and Na of 136 mEq/L; K 4.97 and total Ca 9.61 were normal Blood culture and sensitivity and lumbar puncture were done

Day of admission (Oct. 21, 2010) 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 MKD: Phenobarbital 20-30 Phenytoin: 10-20 Diazepam: 0.3 Topiramate: 0.5

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 Phenobarbital was discontinued

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 due to normal blood CS, normal high-sensitive CRP at 0.42, and negative growth on CSF analysis with high CHON and normal sugar levels Recurrence of seizures almost every hour (1-3 mins/episode) O2 per face mask at 51ppm was given Reloading of phenobarbital 12 mg/SIVP and phenytoin 11 mg/SIVP q12h

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

8th HD (Oct. 29, 2010) Phenytoin was given at 8mg/SIVP per infusion and phenobarbital dose was maintained Topiramate (0.5 mg/kg/day) 25 mg/tab divided into 10 pptabs was given OD Pyridoxine 50 mg/tab 1 tab BID was also started

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)