17 yr female with rat poison intake PO CBBLE UDHC similar cases

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A 17 year female came to casualty with active seizures and history of intake of rat poison 11 days ago. 

HISTORY OF PRESENTING ILLNESS

History of intake of rat poison powder followed by two episodes of vomitings with food as contents and yellowish discoloration of eyes.

History of generalized seizures with the 2-5 episodes for past since 11 days

PAST HISTORY - 

NOT A KNOWN CASE OF  HTN, DM , EPILEPSY , ASTHMA , TB

PERSONAL HISTORY :

DIET - MIXED

APPETITE -NORMAL ,

BOWEL MOVEMENT - REGULAR , 

BLADDER MOVEMENTS - REGULAR, ADDICTIONS(ALCOHOL AND SMOKING) - NO ADDICTIONS

FAMILY HISTORY - 

NAD

ON EXAMINATION -

PATIENT IS CONCIOUS , COHERENT COOPERATIVE

NO PALOR, ICTRUS, CLUBBING , CYANOSIS , LYMPHADENOPATHY , EDEMA

VITALS - 

TEMPERATURE - 98.1

PULSE RATE - 89 BPM

BLOOD PRESSURE - 140/90 MM OF HG 

RESPIRATORY RATE - 18

SPO2 - 99 % AT ROOM AIR

SYSTEMIC EXAMINATION - 

CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS

RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS

CENTRAL NERVOUS SYSTEM : NAD

INVESTIGATION 

DAY 1

PT - 15sec

INR - 1.5

Day 2

Day 6

Day 11

TREATMENT P

INJ. LORAZEPAM 2ML IV

INJ. LEVIPIL 1G IV 

IVF NS @ 75 ML/HR

INJ. PAN 40 MG IV OD

INJ. PHENYTOIN 20MG/KG IV STAT 

F/B 100MG TID

INJ. N-ACETYL CYATEINE 150MG/KG IN 200 ML IN 5DW IN 30 MIN

F/B 50MG/KG IN 500 ML 5DW IN 4HRS

F/B 100MG/KG IN 1000ML OF 5DW IN 16HRS

SOAP NOTES DAY 1, 8PM

S: 

6 episodes of seizure like activity (psudoseizure) since morning

No fever spikes

Not passed stools

No tongue bite,

No bleeding manifestations

O

ON EXAMINATION -

PATIENT IS drowsy, arousable

GCS - E4 V5 M6

NO PALOR, ICTRUS, CLUBBING , CYANOSIS , LYMPHADENOPATHY , EDEMA

VITALS - 

TEMPERATURE - 98.1

PULSE RATE - 90 BPM

BLOOD PRESSURE - 100/60 MM OF HG 

RESPIRATORY RATE - 18

SPO2 - 99 % AT ROOM AIR

SYSTEMIC EXAMINATION - 

CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS

RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS

CENTRAL NERVOUS SYSTEM : NAD

A

Seizures secondary to ?toxin induced encephalopathy

P

INJ. LORAZEPAM 2ML IV

Inj. Sodium valproate 600mg IV BD IN 100ML NS over 30 mins

INJ. LEVIPIL 1G IV 

IVF NS @ 75 ML/HR

Inj. Optineuron 1amp in 100ml ns IV OD

INJ. PAN 40 MG IV OD

INJ. PHENYTOIN 20MG/KG IV STAT 

F/B 100MG TID

INJ. N-ACETYL CYATEINE 100MG/KG IN 1000ML OF 5DW IN 16HRS

SOAP NOTES DAY 2

ICU BED 2

17/F

Day 2

S: 

2 episodes of seizure like activity (psudoseizure) yesterday night and today morning around 5am

No fever spikes

Not passed stools

No tongue bite,

No bleeding manifestations

Pt complaing of chest pain

O

ON EXAMINATION -

PATIENT IS CONSCIOUS AND ALERT

NO PALOR, ICTRUS, CLUBBING , CYANOSIS , LYMPHADENOPATHY , EDEMA

VITALS - 

TEMPERATURE - 98.1

PULSE RATE - 90 BPM

BLOOD PRESSURE - 110/60 MM OF HG 

RESPIRATORY RATE - 18

SPO2 - 99 % AT ROOM AIR

SYSTEMIC EXAMINATION - 

CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS

RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS

CENTRAL NERVOUS SYSTEM : NAD

A

Seizures secondary to ?toxin induced encephalopathy (zinc phosphate)

P

INJ. LORAZEPAM 2ML IV

Inj. Sodium valproate 600mg IV BD IN 100ML NS over 30 mins

INJ. LEVIPIL 1G IV BD

IVF NS @ 75 ML/HR

Inj. Optineuron 1amp in 100ml ns IV OD

INJ. PAN 40 MG IV OD

INJ. PHENYTOIN 20MG/KG IV STAT 

F/B 100MG TID

INJ. N-ACETYL CYATEINE 100MG/KG IN 1000ML OF 5DW IN 16HRS

LFT

TB- 1.98

DB-0.36

AST-19

ALT-25

ALP-101

TP-4.9

ALB-3.0

HEMOGRAM

HB-8.4

TLC-8100

PCV-25.2

MCV-78.5

MCH-26

PLT-2.52

EEG

https://drive.google.com/file/d/15bM7pfhzrIDTw1g-XEFdQItVXlbf5-xB/view?usp=drivesdk

EEG

SOAP NOTES DAY 3

S- 1 episodes of psudoseizure since morning, 

O -

Temp - 98.6

PR - 92

RR- 20

BP- 120/80

SpO2- 98% RA

CVS-S1 S2 +

RS - BAE+ NVBS CNS-NAD

P/A-SOFT NONTENDER

  

A - pseudo seizures and rat poisoning With hypoproteinemia(hypoalbuminemia)

P - tappering AEDs, Psy review today

SOAP NOTES DAY 4

S

1 episode of psudoseizure morning

Further history evaluated - stressor ++ (history confidential)

Unconsious conflict +

O

Temp - 98.5

PR - 72

RR- 16

BP- 120/70

SpO2- 99% RA

CVS-S1 S2 +

RS - BAE+ NVBS CNS-NAD

P/A-SOFT NONTENDER

Psychiatry opinion - dissociative convulsion

A

Paudo seizure secondary to dissociative convulsion

P

Psychotherapy

T. Clonazepam 0.25 mg PO BD

T. Escitalopram 10mg + Clonazepam 0.5mg HS

T. CLONAZEPAM 0.5 MG SOS

SOAP NOTES DAY 5

S

1 episode of psudoseizure morning

stressor ++

Unconsious conflict +

O

Temp - 98.6

PR - 76

RR- 17

BP- 110/70

SpO2- 99% RA

CVS-S1 S2 +

RS - BAE+ NVBS CNS-NAD

P/A-SOFT NONTENDER

A

Paudo seizure secondary to dissociative convulsion

P

Psychotherapy

T. Clonazepam 0.25 mg PO BD

T. Escitalopram 10mg + Clonazepam 0.5mg HS

T. CLONAZEPAM 0.5 MG SOS

Discharge patient