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Discussion

DIlantin?! I'm so scared, please help!!

Nurses, been an LPN for 3 months. Charge nurse on a psych unit. Sweet, confused 57 yo pt with ATOH dementia and seizure disorder went into status epilepticus on my shift at 1:30 pm today. He gets 300 mg Dilantin every morning at 8 am. I worked yesterday as well as today. WHAT IF I FORGOT HIS MEDS two days in a row??? I'm so scared. I don't think I forgot his Dilantin, but what if I did?? He's in ICU now, intubated on Ativan. Can a man with seizure disorder enter status epilepticus even when he's been taking meds as prescribed? My first aid was very good as events unfolded, but now I'm researching and learning most common cause is skipped meds? How many days skipped meds would it take? He got his meds first out of 30 patients today, so I highly doubt I missed the Dilantin but what if I did, I'm human!! I didn't think to check med sheets as I left this evening. Can a person w/ disgnosed seizure disorder enter status epilepticus for a reason other than missed dosing?

:o

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People can also seize when they have levels too high as well, and when they are getting sick before any other symptoms appear...........my daughter takes dilantin and it's brutal watching the levels fluctuate , they usually check levels every month, and alot of times they are too high.....jusy depends on how ones body metabolizes medications. Seizure meds control seizures but they don't stop them.....thats just what I was told by neurologists......you'll be fine...don't worry! ;)

  • Author

KellieNurse, thanks for responding. Nurse after me called to tell me Doc called to ask her to check Dilantin levels most recent labs, and they were WNL. So, how many missed doses would it take, do you think? This job is too much responsibility, too heavy. I try so hard, take it so seriously, and now this. Wonder if they check his Dilantin levels in the hospital and they're too low or high I'll get blamed?

  • Expert

oldnewnurse - please don't worry about this. A person who has seizures can seize for many reasons other than missed doses and most involve an as yet unidentified illness. Please don't blame yourself. It sounds like you handled everything just fine. Please don't fret anymore.

KellieNurse, thanks for responding. Nurse after me called to tell me Doc called to ask her to check Dilantin levels most recent labs, and they were WNL. So, how many missed doses would it take, do you think? This job is too much responsibility, too heavy. I try so hard, take it so seriously, and now this. Wonder if they check his Dilantin levels in the hospital and they're too low or high I'll get blamed?

Wow..I would think because of trough levels at the least 24 hours...but I am no doc nor lab tech...so I honestly don't know.....you are getting nervous over nothing........really!

I can tell you by personal experience though....my daughter used to take liquid Dilantin....can we say nightmare???? Even with shaking & over shaking.......just an all around nightmare...so being the mom..I asked for tablets....can't be more simpler than that right???? I can tell you my daughter had levels of 60 something and had hers held for almost a week before when she was admitted to the hospital when she was sick and then it finally started coming down..she also requires her dose to 1/4 of what a normal average person her age takes due to the way her body metabolizes medications............you have to look at the "big picture" ..I am still a student...not an RN yet but I have learned most of what I know thinking wise to the nurses who come into my home to take care of my daughter..........I have learned lots of stuff....so much so that I even surprise myself at times...lol....BUT I know once I am out there working that I will feel comfortable enough not to let most things rattle me..........so relax.......you did nothing wrong!!!!! Let us know how you are doing.......

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