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CASE PROTOCOL

SEIZURE

This is the case of BAV a 7 year old female, catholic, Filipino, Born on the 8th of February, 2010 at Metro
Manila and is currently residing at 17C Alchan St, Barangka Itaas Mandaluyong City. The patient was
admitted last September 19, 2017. This is the patients second admission in our institution. The patients
parents are the informants with a percent reliability of 90%.

The patient came to the Emergency Room with the Chief Complaint of Seizure.

Two weeks prior to admission, during a choir rehearsal at their church. The patient suddenly lost
consciousness and had seizures of 1-2 minutes duration. The post-seizure state lasted for about 5
minutes. The patient was brought to their pediatrician and was referred to a Pediatric Neurologist. An
EEG was done revealing focal epileptiform discharges. The patient was sent home with Levetiracetam
(Keppra) of unrecalled dosage.

Interim was unremarkable and the parents claimed good medical compliance.

Two hours prior to admission, the patient arrived at home from school feeling weak and sickly. Few
minutes after the patient developed seizure of 1-2 minutes duration, with associated vomiting of
previously ingested food. The patient was unconscious for more than an hour which the father thought
was unusual from the previous duration of post-seizure state. The patient was immediately brought to
the Emergency room. According to the father, during their travel to the hospital, the patients left arm
was shaking.

At the Emergency Room, the patient was still unconscious. On Physical Examination, The patient was
afebrile with tachycardia (150bpm). The patient withdraws to pain, no verbal responses, and with eye
opening to calling her name equivalent to a Glasgow Coma Score of 8 (M4V1E3). There was observed
horizontal nystagmus, and a right preferential gaze of the eyes. The head was also tilting to the right
side with stiff and with difficulty turning midline. The rest of the physical examination were
unremarkable. A closer look of the patient also showed stiffening of the upper extremities. A Capillary
Blood Glucose was done showing normal results (121mg/dl). The patient was advised admission to the
Pediatric ICU.

Upon admission, the patient was put on temporary NPO. The patient was hooked to cardiac monitor
and O2 at 5lpm via face mask. Venoclysis was done and hooked to D5NM 1L to run 70cc/hour (M). The
patient was started on Phenobarbital 270mg very slow through infusion pump over 30 minutes then
90mg IV slow infusion pump every 24 hours. Levetiracetam IV 500mg every 12 hours. Vital signs and
Neurologic Vital signs were monitored and were recorded. Patient was put on a side lying position with
a 30 degree head elevation.

On the first hospital day, the patient was drowsy but is arousable and is able to answer questions when
asked. Vital signs were stable. Physical examination was unremarkable. IVF and medications were
continued. Patient was then put on soft diet. By the afternoon, the patient was transferred to a regular
room. IVF and Medications were continued.

On the second hospital day, there was significant improvement observed on the patient and was
deemed fit for discharge. Hence the patient was sent home with home medications.