19F presented with involuntary movements and yellowish discoloration of sclera

A 19 year female came to casualty with active seizures and a history of intake of rat poison 11 days ago. 

HISTORY OF PRESENTING ILLNESS

History of intake of rat poison powder followed by two episodes of vomiting with food as contents and yellowish discoloration of eyes.

History of generalized seizures with the 2-5 episodes for past since 11 days

11 days back there was a disturbance in the family in between the patient and her father due to alteration in the career of the patient. Due to that disturbance, she made a suicide attempt by ingesting rat poison powder.

Then they went to nalgonda govt hospital and were admitted on the same day .Then on the next day she got 1 episode of a seizure.

Then she continued to have seizures of 5 to 6 episodes every day. 

They were referred to our hospital .

PAST HISTORY - 

NOT A KNOWN CASE OF  HTN, DM , EPILEPSY , ASTHMA , TB

PERSONAL HISTORY :

DIET - MIXED

APPETITE -NORMAL ,

BOWEL MOVEMENT - REGULAR , 

BLADDER MOVEMENTS - REGULAR, ADDICTIONS(ALCOHOL AND SMOKING) - NO ADDICTIONS

FAMILY HISTORY - 

NAD

ONEXAMINATION -

PATIENT IS CONCIOUS , COHERENT COOPERATIVE

NO PALOR, ICTRUS, CLUBBING , CYANOSIS , LYMPHADENOPATHY , EDEMA

VITALS - 

TEMPERATURE - 98.1

PULSE RATE - 89 BPM

BLOOD PRESSURE - 140/90 MM OF HG 

RESPIRATORY RATE - 18

SPO2 - 99 % AT ROOM AIR

SYSTEMIC EXAMINATION - 

CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS

RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS

CENTRAL NERVOUS SYSTEM : NAD

INVESTIGATION 

DAY 1

PT - 15sec

INR - 1.5

Day 2

                DAY 6                               

           DAY 11

• TREATMENT P
  INJ. LORAZEPAM 2ML IV
  INJ. LEVIPIL 1G IV 
  IVF NS @ 75 ML/HR
  INJ. PAN 40 MG IV OD
  INJ. PHENYTOIN 20MG/KG IV STAT 
  F/B 100MG TID
  
  
  
  INJ. N-ACETYL CYATEINE 150MG/KG IN 200 ML IN 5DW IN 30 MIN
  F/B 50MG/KG IN 500 ML 5DW IN 4HRS
  F/B 100MG/KG IN 1000ML OF 5DW IN 16HRS
  
  
  SOAP NOTES DAY 1, 8PM
  S: 
  6 episodes of seizure like activity (psudoseizure) since morning
  No fever spikes
  Not passed stools
  No tongue bite,
  No bleeding manifestations
  
  
  
  
  
  
  ONEXAMINATION -
  
  
  PATIENT IS drowsy, arousable
  GCS - E4 V5 M6
  NO PALOR, ICTRUS, CLUBBING , CYANOSIS , LYMPHADENOPATHY , EDEMA
  
  
  VITALS - 
  
  
  TEMPERATURE - 98.1
  PULSE RATE - 90 BPM
  BLOOD PRESSURE - 100/60 MM OF HG 
  RESPIRATORY RATE - 18
  SPO2 - 99 % AT ROOM AIR
  
  
  SYSTEMIC EXAMINATION - 
  
  
  CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS
  RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS
  CENTRAL NERVOUS SYSTEM : NAD
  
  
  A
  Seizures secondary to ?toxin induced encephalopathy
  
  
  P
  INJ. LORAZEPAM 2ML IV
  
  
  Inj. Sodium valproate 600mg IV BD IN 100ML NS over 30 mins
  
  
  INJ. LEVIPIL 1G IV 
  
  
  IVF NS @ 75 ML/HR
  
  
  Inj. Optineuron 1amp in 100ml ns IV OD
  
  
  INJ. PAN 40 MG IV OD
  
  
  INJ. PHENYTOIN 20MG/KG IV STAT 
  F/B 100MG TID
  
  
  INJ. N-ACETYL CYATEINE 100MG/KG IN 1000ML OF 5DW IN 16HRS