GENERAL PROFILE

• PA
• 6MOS OLD
• FEMALE
• FILIPINO
• ROMAN CATHOLIC
• ALANG-ALANG MANDAUE CITY
 CHIEF COMPLAINT

• GENERALIZED TONIC-CLONIC SEIZURES

 HISTORY OF PRESENT ILLNESS

• 8 HOURS PTA, PATIENT HAD ONSET OF GENERALIZED TONIC-CLONIC SEIZURES

WITH UPWARD ROLLING OF EYEBALLS, CIRCUMORAL CYANOSIS
• 6 HOURS PTA, PATIENT HAD ANOTHER SEIZURE EPISODE
• NO FEVER, COUGH, OR CORYZA ASSOCIATED.
 PRENATAL, NATAL, POST NATAL

• PRENATAL
• BORN TO A 32 YR OLD G2P2 MOTHER POSTNATAL
• 1ST PNC AT 2 MOS AOG AT LHC • FEEDING: BREASTMILK
• WITH NO KNOWN MATERNAL ILLNESSES
• PRENATAL MV: MV+ FE

• NATAL
• BIRTH RANK 2/2
• DELIVERED VIA NSD AT A LYING IN CLINIC
• GESTATION: FULL TERM
• BW: 3,000 GRAMS
• NO PERTINENT PERINATAL HISTORY
• ENBS RESULTS: NORMAL
 IMMUNIZATIONS

• BCG
• PENTA HIB 1,2,3
• OPV 1,2,3
• PCV 1,2,3
 PAST MEDICAL HISTORY

• UNREMARKABLE
 FAMILY HISTORY

• HYPERTENSION ON MATERNAL SIDE

• NO FAMILY HISTORY OF SEIZURES
 PHYSICAL EXAMINATION

• AWAKE, ALERT, NOT IN RESPIRATORY DISTRESS

• WT: 6.5 KG
• VITAL SIGNS:
• TEMP: 37
• PR 131
• RR 33
• O2 SAT: 98 % AT ROOM AIR
 PHYSICAL EXAMINATION

• HC:40.5CM
• SKIN: WARM, GOOD TURGOR
• HEENT: AIS, PPC, (-) LAD
• C/L: ECE, CBS, NO RALES, NO WHEEZE
• CVS: DHS, REGULAR RATE AND RHYTHM, (-) MURMUR
• ABD: GLOBULAR, SOFT , NONDISTENDED, NO ORGANOMEGALY
• EXT: STRONG PERIPHERAL PULSES, CRT <2 SECS
• CNS: CN XII-NOT ASSESSED
• CN I- NOT ASSESSED
MENINGEAL SIGNS: NEGATIVE
• CN II- NOT ASSESSED BRUDZINSKI’S SIGN AND KERNIG’S
• CN III, IV, VI- PERRLA, EOMI SIGN
• CN V- NOT ASSESSED
• CN VII- NO FACIAL ASYMMETRY
• CN VIII- HEARING NORMAL
• CN IX, X- GAG REFLEX PRESENT
 ON THE DAY OF ADMISSION

• PATIENT WAS SUBSEQUENTLY ADMITTED AND REFERRED TO PEDIATRIC

NEUROLOGIST FOR CO-MANAGEMENT.
• SEIZURE PRECAUTIONS
• VENOCLYSIS STARTED WITH PNSS @27 CC/HR
• THE PATIENT HAD 1 EPISODE OF GENERALIZED TONIC CLONIC SEIZURE WITH
UPWARD ROLLING OF EYEBALL ASSOCIATED WITH CIRCUMORAL CYANOSIS
LASTING FOR 1 MINUTE
 LABS

CBC NORMAL PATIEN

Normal Patient T
Hemoglobin 11-20 10.6 L Serum Na 137-145 140
Hematocrit 35-49% 30.7 L Serum K 3.5-5.1 4.7
Platelet Count 140-440 392 Crea 0.7-1.2 0.20
WBC 6.0-17.0 6.54 SGPT <35 23
Differential count
Neutrophils 45-65 33 CXR
Lymphocytes 20-40 60 H
Monocytes 2-9 5 CONSIDER A RETROCARDIAC
Eosinophils 0-6 2 PNEUMONIA
Basophils 0-2 0
 MEDICATIONS

• DIAZEPAM 2MG IVTT PRN FOR ACTIVE SEIZURES WITH AD 0.3MKD

 HOSPITAL DAY 1
• S: AWAKE, ALERT, NO RECURRENCE OF SEIZURES
• O:
• VITAL SIGNS: T 36 PR 112 RR36 O2 SAT 100% @RA
• SKIN: WARM, GOOD TURGOR
• HEENT: AIS, PPC, (-) LAD
• C/L: ECE, CBS, NO RALES
• CVS: DHS, REGULAR RATE AND RHYTHM, (-) MURMUR
• ABD: SOFT , NONDISTENDED, NO ORGANOMEGALY
• EXT: STRONG PERIPHERAL PULSES, CRT <2 SECS

• A: EPILEPSY, GENERALIZED ONSET ETIOLOGY TO BE DETERMINED

• P-STARTED ON OXCARBAZEPINE 60MG/ML 0.75 ML 2X A DAY

 HOSPITAL DAY 2
• S: AWAKE, ALERT, ACTIVE, PLAYFUL, NO RECURRENCE OF SEIZURES
• O:
• VITAL SIGNS: T 37 PR 126 RR 36 O2 SAT 100% @RA
• SKIN: WARM, GOOD TURGOR
• HEENT: AIS, PPC, (-) LAD
• C/L: ECE, CBS, NO RALES
• CVS: DHS, REGULAR RATE AND RHYTHM, (-) MURMUR
• ABD: SOFT , NONDISTENDED, NO ORGANOMEGALY
• EXT: STRONG PERIPHERAL PULSES, CRT <2 SECS

• A: EPILEPSY, GENERALIZED ONSET ETIOLOGY TO BE DETERMINED

• P: STARTED ON OXCARBAZEPINE 60MG/ML 0.75 ML 2X A DAY WITH AD OF 7MKD
• IVF SHIFTED TO HEPLOCK
 HOSPITAL DAY 3
• S: AWAKE, ALERT, PLAYFUL, NO RECURRENCE OF SEIZURES
• O:
• VITAL SIGNS: T 36.2 PR 96 RR 36 O2 SAT 100 %@RA
• SKIN: WARM, GOOD TURGOR
• HEENT: AIS, PPC, (-) LAD
• C/L: ECE, CBS, NO RALES
• CVS: DHS, REGULAR RATE AND RHYTHM, (-) MURMUR
• ABD: SOFT , NONDISTENDED, NO ORGANOMEGALY
• EXT: STRONG PERIPHERAL PULSES, CRT <2 SECS

• A: EPILEPSY, GENERALIZED ONSET ETIOLOGY TO BE DETERMINED

• P- CLEARED FOR DISCHARGE
 DISCHARGE INSTRUCTIONS

• TAKE HOME MEDS:

• OXCARBAZEPINE 60MG/ML 0.75 ML 2X A DAY

• EEG AS OUTPATIENT
THANK YOU