I was taking care of a pt. 38 y/o WM who has been incarcerated for around 20 years brought into ER two days ago with high fever and decreased LOC and had a seizure at the prison he was at. Fever waas 101.8 which was brought down by tylenol 650mg rectally q6h prn temp >101.0 took tow doses and he was put on 0.9% NS @ 70cc/h. Cat scan was negative, CXR was normal. V/S in Er and once he was admitted have remained normal except for the two high temps and now they have been running 97.9 F to 98.9 F V/S are Spo2 98% on RA, BP- 136/82, P-78, R- 18. Lungs clear, BS active in all 4 quads, S1 + S2 wnl, no gallop or mumur heard, EKG shows Sinus Arrythmia, lab work all WNL, no elevated WBC , BS was 108 in ER, no hx of IDDM or DM. Pt.. has hx of epilepsy since he was born on Depakote 250mg PO BID. Pt. is still two days later disorienteted, doesn't know where he is , why he is @ the hospital or anything, or even his name. Pt. also has a foley and is putting out clear, yellow urine. Blood cultures are negative @ 48 hours, Urine cultures are negative @ 48 hours growth. Doc did a LP and it is normal, nothing wrong there. The Doc os thinking of West Nile virus, bt he isn't for sure, so he is getting ready to transfer him to a Level one Truama/Teaching hospital via ambulance with ALS today. Let me know what yall think about what might be going on with this pt.
Sep 7, '02
I'm wondering what his depakote level was, and about results of drug screens...as to confusion/disorientation??? Also is it possible initial temp from dehydration, and or heat exposure?? Just wondering here..
Last edit by Brownms46 on Sep 7, '02
May 3, '05
Last edit by rjflyn on May 3, '05
: Reason: oops two year old + post
May 4, '05
LFT's and any other psychotropics? Sinus Arrythmia?
Last edit by MikeLPN on May 4, '05
May 6, '05
he had a seizure secondary to epilepsy, despite being on depakote. the post-ictal phase can last for several days -- this would explain the disorientation. maybe his medication needs to be changed, or an additional med added (ie. maybe it's no longer controlling the seizures). here is a great link:
it's normal to have a temp after a seizure. i don't know if <102 is really that high, but according to this link:
"a high temperature
suggests the possibility of cns infection or a hyperpyrexia syndrome (neuroleptic malignant syndrome, heat stroke, thyroid storm, sympathomimetic or anticholinergic drug intoxication); a mildly elevated temperature can be secondary to the generalized convulsions"
as for his loc:
"a failure of the loc to progressively "lighten"
after the seizure ceases suggests the possibility of non-convulsive status epilepticus, drug overdose, a metabolic coma, or intracranial pathology causing an increased icp"
also, it said that 50% of ct scans can be normal.
additionally, the depakote level may have been "sub-therapeutic":
"if the seizure was a recurrent seizure in a patient with a known seizure disorder + seizure pattern is similar to previous seizures => only order serum anticonvulsant drug levels => administer an additional dose of anticonvulsant if the serum anticonvulsant level is sub-therapeutic"
read the link, it's really in-depth!
Last edit by lady_jezebel on May 6, '05