TY  - CHAP
M1  - Book, Section
TI  - Case Study 2
A1  - Hoffman, Robert S.
A1  - Howland, Mary Ann
A1  - Lewin, Neal A.
A1  - Nelson, Lewis S.
A1  - Goldfrank, Lewis R.
Y1  - 2015
N1  - 
T2  - Goldfrank's Toxicologic Emergencies, 10e
AB  - HistoryParents  called  911  because  they  found  their  5  year-old  girl  at  home  unresponsive.  Shortly  before  emergency  medical  services  (EMS)  arrived,  the  girl  had  a  witnessed  self  limited  seizure  that  the  parents  described  as  the  sudden  onset  of  unresponsiveness  with  repetitive  shaking  and  urinary  incontinence.  When  EMS  arrived,  she  was  no  longer  shaking  but  could  not  be  aroused.  The  paramedics  recorded  a  respiratory  rate  of  30  breaths/min  with  a  pulse  of  150  beats/min  and  a  point-of-care  glucose  of  122  mg/dL.  They  administered  oxygen  via  nasal  cannula  and  brought  her  to  the  emergency  department.On  arrival  at  the  hospital,  the  parents  reported  that  the  child  had  no  significant  past  medical  history,  had  a  pediatrician,  was  current  with  all  vaccinations,  and  was  not  taking  any  prescription  medications.  Although  she  had  a  mild  cough  and  nasal  congestion,  she  was  able  to  attend  kindergarten  the  previous  day.  As  further  history  was  being  obtained,  the  child  began  to  shake  repetitively  once  again.Immediate  Assessment  and  ManagementThe  child  was  given  an  intramuscular  injection  of  lorazepam  (2  mg;  0.1  mg/kg  for  an  estimated  weight  of  20  kg)  while  an  intravenous  (IV)  line  was  being  inserted.  Within  a  few  moments  the  shaking  stopped.  Blood  samples  were  sent  for  a  complete  blood  count  and  electrolytes  and  an  electrocardiogram  (ECG)  was  ordered.  The  child  was  attached  to  continuous  cardiac  monitoring  and  repeat  vital  signs  were:  blood  pressure,  108/80  mm  Hg;  pulse,  155  beats/min;  respiratory  rate,  32  breaths/min;  rectal  temperature,  99.4oF  (37.4°C);  oxygen  saturation,  100%  on  a  100%  nonrebreather  face  mask;  and  glucose,  143  mg/dL.  Physical  examination  revealed  a  normal  head  without  signs  of  trauma,  pupils  that  were  4  to  5  mm  and  reactive,  a  clear  chest,  normal  heart  sounds,  a  soft  abdomen  with  normal  bowel  sounds,  and  skin  that  was  without  rashes  or  other  abnormalities.  The  child  was  still  not  verbal  but  appeared  to  localize  pain  and  moved  all  extremities,  and  she  had  normal  muscle  tone.  Unfortunately,  the  patient  began  to  seize  again.  IV  lorazepam  (2  mg)  was  given  with  nearly  an  immediate  response.  Repeat  vital  signs  and  physical  examination  was  essentially  unchanged.What  Is  the  Differential  Diagnosis?In  addition  to  idiopathic  epilepsy,  trauma,  infections,  and  structural  brain  lesions,  seizures  can  result  from  exposure  to  ­countless  xenobiotics  and  even  withdrawal.  In  most  instances,  ­seizures  are  usually  single  and  either  self-­limited  or  respond  easily  to  an  appropriate  dose  of  a  benzodiazepine.  This  child  had  three  seizures  in  a  brief  period  of  time  without  regaining  consciousness,  which  meets  criteria  for  status  epilepticus.  Although  seizures  are  common,  status  epilepticus  is  rare,  thereby  narrowing  the  differential  diagnosis  to  xenobiotics  found  in  Table  CS2–1.Is  There  a  Clinical  Difference  between  Drug-Induced  Seizures  and  Idiopathic  Epilepsy?Several  features  distinguish  toxic-metabolic  seizures  from  idiopathic  epilepsy.  First  and  foremost  is  that  with  few  exceptions,  toxic-metabolic  seizures  often  fail  to  respond  to  phenytoin.  Although  phenytoin  is  an  excellent  second  line  anticonvulsant  after  benzodiazepines,  it  either  has  no  efficacy  or  is  actually  detrimental  in  diverse  toxicological  etiologies  from  alcohol  withdrawal  or  seizures  induced  by  dysrhythmias,  theophylline,  cyclic  antidepressants,  anticonvulsants,  and  or  cocaine.  Conceptually,  phenytoin  fails  because  its  ability  to  ...
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accesspharmacy.mhmedical.com/content.aspx?aid=1108439035
ER  -