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    Peter Francis Raguindin
    Isabella, a 21-year-old female with a 7-year history of seizures, was brought to the emergency room experiencing prolonged seizures. Her seizures had been increasing in frequency over the past month. On admission, she was intubated and found to be stuporous with abnormal vital signs and laboratory results. Despite resuscitative efforts, her condition deteriorated and she died on her fourth day in the hospital.

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    36 TH

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    Peter Francis Raguindin
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    Isabella, a 21-year-old female with a 7-year history of seizures, was brought to the emergency room experiencing prolonged seizures. Her seizures had been increasing in frequency over the past month. On admission, she was intubated and found to be stuporous with abnormal vital signs and laboratory results. Despite resuscitative efforts, her condition deteriorated and she died on her fourth day in the hospital.

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    Isabella, a 21-year-old female with a 7-year history of seizures, was brought to the emergency room experiencing prolonged seizures. Her seizures had been increasing in frequency over the past month. On admission, she was intubated and found to be stuporous with abnormal vital signs and laboratory results. Despite resuscitative efforts, her condition deteriorated and she died on her fourth day in the hospital.

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    31 views2 pages

    36 TH

    Uploaded by

    Peter Francis Raguindin
    Isabella, a 21-year-old female with a 7-year history of seizures, was brought to the emergency room experiencing prolonged seizures. Her seizures had been increasing in frequency over the past month. On admission, she was intubated and found to be stuporous with abnormal vital signs and laboratory results. Despite resuscitative efforts, her condition deteriorated and she died on her fourth day in the hospital.

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    of 2

    35 INTERSCHOLASTIC CLINICOPATHOLOGIC CONFERENCE CLINICAL ABSTRACT

    th

    General information This is the case of Isabella, a 21 year old female from Fork Street, who was brought to the emergency room for was there any previous diagnosis of Epilepsy? prolonged seizures.
    we should rule-out other causes of seizures.

    History related to present illness: The patient has been having seizure episodes for the past 7 years and was maintained on oral Phenobarbital albeit with poor compliance. She would have 1 to 3 episodes of generalized convulsions per month but was well in between attacks. She was an average student, but never got to finish high school. 1 month prior to admission, Bella's seizure episodes increased in frequency. 1 day prior to admission, she had 10 episodes lasting for 30 seconds each but she regains consciousness in between. Later that day, she began having difficulty eating and was noted to sleep longer. No cyanosis or pallor was noted. On the morning of admission, Bella had more than 10 seizures in a span of 2 hours and was not conscious in between attacks. The persistence of seizures and the decrease in sensorium prompted consult and subsequent admission.
    poor compliance to medication

    Physical Examination on Admission (Examined intubated) is one of the most common The patient arrived drowsy and was immediately intubated. reason for status epilepticus Stuporous, with eye opening to pain, localizes to pain BP 100/70 HR 118 RR assisted T 38.5oC Numerous macules and papules on the face, neck and anterior chest area Harsh equal breath sounds, (+) rales, (-) wheezes Adynamic precordium, tachycardic, regular rhythm, no murmurs Flat abdomen, normoactive bowel sounds, soft, no palpable internal organs Pink nailbeds, no edema, full equal pulses
    no focal neurologic deficits, Neurologic Exam (on examination) anatomic causes of epilepsy Stuporous, intubated unlikely unless very small so Pupils 2-3 mm equal, bilaterally reactive to light as not to cause neurologic (-) ptosis deficits. at this point, (+) Dolls eye reflex probable causes are Brisk corneal reflexes, bilateral metabolic, chronic infectious, avm No facial asymmetry (+) gag reflex Can move head to left and right Good shoulder contour Motor: spontaneous movement of all extremities against gravity and resistance DTR: ++ Equivocal Babinski's sign (-) nuchal rigidity, (-) Kernig, (-) Brudzinski (-) clonus Sensory: the patient localizes to pain.

    patient already had hypoxicischemic encephalopathy secondary to status epilepticus!

    Course in the Wards and Circumstances Surrounding Demise Hospital day 1: After 2 hours, patient self-extubated but was noted to be ventilating spontaneously without much effort. The patient was noted to be drowsy but easily arousable. Verbal output was limited to incomprehensible sounds. She showed non-purposeful movements. Patient had no seizures while in the emergency room. The following were the results of the laboratory exams done at the emergency room (Day 1) (see summary of laboratories). Patient was scheduled for CT-scan, EEG, and chest x-ray but these were not done. Hospital day 4: The patient's sensorium decreased. Patients vital signs were previously stable. Patient was REINTUBATED due to decreased sensorium, and thick white secretions per ET tube was noted. Patient was GCS3, with 3 mm non-reactive to light right eye and 4 mm non-reactive to light left eye. Patient was noted to have chewing movements. Patient was given Phenytoin per IV. Patient went to cardiac arrest. Resuscitative efforts were futile, and patient died. Summary of Laboratories Chemistry BUN Glucose Creatinine Albumin ALT Calcium Magnesium Sodium Potassium Chloride Hematology WBC RBC Hgb Hct MCV MCH MCHC RDW-CV Platelet Neutrophils Lymphocytes Monocytes Eosinophils Basophils Day 1 17.12 4.82 120 0.376 78.0 24.9 319 15.1 471 0.842 0.099 0.057 0.001 0.001 Reference Values 4 11 x 109/L 4 6 x 1012/L 120 180 g/L 0.370 0.540% 80.0 100.0 fL 27.0 31.0 pg 320 360 g/L 11.0 16.0% 150 450 x 109/L 0.500 0.700 0.200 0.500 0.020 0.090 0.000 0.060 0.000 0.020 Day 1 8.53 3.61 252 44 20 2.99 1.58 140 5.1 112 Day 2 Reference Values 2.50 7.10 mmol/L 3.90 6.10mmol/L 53 - 115umol/L 34 50 g/L 30 65 U/L 2.12 2.52 mmol/L 0.74 1.00 mmol/L 140 168 mmol/L 3.6 5.2 mmol/L 100 108 mmol/L Prothrombin Time, Day 1 Control 13.2 Patient 14.9 Activity 0.63 INR 1.26

    341

    Activated Partial Thromboplastin Time, Day 1 Control 36.9 Patient 36.7 Blood Gas, Day 1 pH pCO2 pO2 HCO3 TCO2 BEb O2Sat

    7.316 15.20 139.00 7.70 8.10 -14.4 98.90

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