1. COURSE IN THE WARD

2. 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

3. 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

4. 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

5. Day of admission (Oct. 21, 2010)
Referral to Pediatric Neurology (Diagnosis: Seizure disorder, etiology to be determined)
MRI with contrast showed normal findings

6. 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

7. 2nd - 4th HD (Oct. 23-25, 2010) No episodes of seizure
Phenobarbital was discontinued

8. 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

9. 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

10. 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 and low phenytoin of 1.20

11. 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

12. 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

13. 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

14. 14th HD (Nov. 4, 2010) 21 channel EEG was done
The rest of the hospital stay was unremarkable.

15. 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)

16. 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)