this is an case on hyponatraemic seizures caused because of low levels of sodium (dehydration), which is the complication of the dengue

1. Presented by :
B.Sunil Kumar Nayak

2. Patient Name : XYZ
Age : 6 Yrs
Sex :Male
Weight :16 Kgs
Unit : Paediatric Ward

3.  C/O Fever since 5 days gradual in onset, low-grade,
continuous and relived with medication.
 History of vomiting 3 episodes/day, which is non-
progressive 1 week back and pain in abdomen and
cough.

4.  MEDICAL HISTORY :- History of birth asphyxia
 MEDICATION HISTORY :-Syp.Paracetamol
 FAMILY HISTORY :-Nothing significant
 SOCIAL HISTORY :-Nothing significant

5. S - Subjective Evidence
O - Objective Evidence
A - Assessment
P - Planning

6.  PROVISIONAL DIAGNOSIS:-
Fever under evaluation….?

7. Dengue test : Negative
Widal test : Negative
M.P Examination : Negative
Platelet count : 75k (1.70-4.50 L/cumm)
Hb : 8.7 g/dl (11-16.5)
Sr.Sodium : 124 m.mol/lit (135-145)
Sr.Potassium : 4.7 m.mol/lit(3.5-5.0)
Sr.Chlorides : 93 m.mol/lit( 90-110)
FINAL DIAGNOSIS:-
DENGUE LIKE ILLNESS WITH
HYPONATRAEMIC SEIZURES

8.  To maintain the body temperature
 To relieve from vomitings
 To prevent the reoccurance of the seizures

9. S.I
NO
DRUGS
(Generic names)
DOSE ROA FRE DA DS
1 N.S 1 pint I.V 1 4
2 Sod.citrate, Pot.chloride, Sod.chloride,
Dextrose
1 sachet in
200ml water
PO - 1 4
3 Syp.Paracetamol 250mg PO TID 1 4
4 Inj.Ondansetron 2cc IV SOS 1 4
5 Inj.Artesunate 48mg IV OD 2 4
6 Inj.Cefotaxim 800mg IV BID 3 4
7 Inj.Paracetamol
(if temp > 102F)
500mg IV SOS 3 4
8 Tab.Artesunate+Pyrimethamine+Sulfadoxi
me
200+2.5+50
0mg
PO OD 4 4

10. S.I
NO
DRUGS DOSE ROA FREQ DA DS
9 Inj.Midazolam 1.5cc+0.5ccNS Slow
IV
OD 4 4
10 Inj.Phenytoin 40mg+100cc NS Slow
IV
BD 4 7
11 Inj.Ceftriaxone 800mg IV BD 4 8
12 Inj.Vit-K 5mg IV Stat 4 4
13 Inj.Ranitidine 3mg/kg IV BD 5 8
14 Syp.sucralfate 2.5 ml PO BD 5 8
15 Supp.Bisacodyl - R.S HS 5 6
16 Syp.Ranitidine 2ml PO BD 8 8

11. DAYS PROGRESS
DAY
-1
O/E: Temp:101F, Facial puffiness, Erythema, P/A: Diffuse
tenderness, PR:130bpm, RR:46/min, BP:80/40mmhg, Mild
dehydratation
LAB DATA
Blood Urea: 29mg/dl, Sr.Creatinine:0.8mg/dl
Dengue, Widal, Malaria test :- Negative
Platelets:75k/cumm, R.B.C:6.7mill/cumm, W.B.C:
3.9kcells/cumm, Hb:8.7g/dl
N-53%, L-42%, M-2%, E-2%, B-0%
DAY-2  C/o:Fever at 18:00
 O/E: PR:112/min, BP:90/60mmhg, CVS:s1s2+
LAB DATA
Hb:8.5g/dl, W.B.C:7k cells/cumm, R.B.C:3.9 mill/cumm,
Platelets:1L/cumm, E.S.R:25mm/1hr, Recticulocyte:1%,
PCV:28vol%, MCV:73fl, MCHC:29%, MCH:21pg
N-60%, L-35%, E-2%, M-3%, B-0%

12. DAYS PROGRESS
DAY-3 O/E:Child is active. Febrile spikes+ PR:116/min,
BP:90/60mmhg, RR:48/min, CVS:s1s2+
LAB DATA
W.B.C:6.6K cells/cumm, R.B.C:3.9mill/cumm, Hb:8.5 g/dl,
Platelets:1.08L/cumm
N-64%, L-32%, M-3%, E-1%, B-0%
Sr.Na+:133m.mol/L, Sr.k+:4.9m.mol/L, Cl-:105m.moil/L
DAY-4 O/E:child is c/c, Afebrile, BP:90/60mmhg,PR:120/min
C/O 1 episode of seizure-GTCS with froathing, tongue bite,
bowel and bladder incontinence lasted for 15 minutes.
GRBS:157mg/dl, Prothrombin time:16.8sec, INR:1.2,
APTT:38.2sec
Sr.Sodium:124m.mol/L, Sr.Pot:4.7m.mol/L, Sr.Cl:93m.mol/L,
Sr.calcium:8.5mg/dl

13. DAY PROGRESS
DAY-5 C/O:Fever spike@5:40, Burning in stomach and
constipation
No fresh seizure activity, BP:110/70mmhg, PR:118/min,
Urine Electrolytes
Sodium :158 m.mol/L (40-120)
Pot : 111 m.mol/L (25-125)
Cl :164 m.mol/L (110-250)
DAY-6 O/E:No fresh complaints, Afebrile
BP:100/70mmhg, PR:100/min, RS:BAE+
DAY-7 O/E:child is c/c, No fresh complaints, No seizure activity,
Afebrile
PR:L108/min, BP:100/60mmhg, RR:32/min, RS:BAE+
DAT-8 C/O:Mild fever at night(99F)/
O/E Child is c/c, P/A:soft, RR:28/min, PR:98/min,
BP:100/60mmhg

14.  Body temperature is maintained.
 No other complications of Dengue were observed.
 Other symptoms like vomiting are also subsided.
 No reoccurrence of seizures.

15.  Sr.Sodium levels should be carefully monitored.
 Temperature should be monitored once in 4 hrs.
 Body fluids should be maintained.

16.  Hospital acquired hyponatraemia
It is a particular concern in children, as the
standard care in pediatrics has been to administer
hypotonic fluids (sodium chloride) as maintenance
fluids.
 Overdose of potchlor
By this, the fluid balance is altered and
excess of extracellular fluid is seen

17.  Discharge medications:
1.syp.Amoxcillin+clavulanate
4ml-po-bid
2.syp.Ranitidine
2ml-po-bid
3.syp.Paracetamol
5ml-sos
4.syp.Multivitamins
5ml-po-od

18. 1.About Disease
2.About Medication
3.About life style modifications