ACUTE MENINGOENCEPHALITIS
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Transcript of ACUTE MENINGOENCEPHALITIS
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CASE PRESENTATION ON ACUTE MENINGOENCEPHALITISWITH SEIZURES
Presented byNIKHIL SINGH
M.PHARMNIPER,HAJIPUR
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INTRODUCTION
ENCEPHALITIS• Encephalitis is an acute inflammatory process affecting
the brain• Viral infection is the most common and important cause,
with over 100 viruses implicated worldwideSymptoms
• Fever• Headache• Behavioral changes• Altered level of consciousness• Seizures
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Causes of Viral Encephalitis
• Herpes viruses – HSV-1, HSV-2, varicella zoster virus, cytomegalovirus, Epstein-Barr virus, human herpes virus 6
• Adenoviruses• Influenza A• Enteroviruses, poliovirus• Measles, mumps, and rubella viruses• Rabies• Arboviruses – examples: Japanese encephalitis; St. Louis
encephalitis virus; West Nile encephalitis virus; Eastern, Western and Venzuelan equine encephalitis virus; tick borne encephalitis virus
• Bunya viruses – examples: La Crosse strain of California virus• Reoviruses – example: Colorado tick fever virus• Arenaviruses – example: lymphocytic choriomeningitis virus
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MENINGOENCEPHALITIS• MENINGOENCEPHALITIS:- Inflammation in brain
membrane.Brain is covered by three layers1)Pia-matter (innermost layer)2)Arachnoid-matter (middle layer)3)Dura-matter (outer layer)
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OBJECTIVE FINDINGS• AGE : 9 MONTHS• SEX : MALE• WEIGHT : 7Kg• BP : 110/70mm Hg• HR : 129/min• Case Reference: IGIMS, Patna, Bihar
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CHIEF COMPLAINTS
1. FEVER × 2 DAYS
2. SEIZURES × 4 – 5 EPISODES
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INVESTIGATION NORMAL RANGE D1 D3 D7 D14
Hb 13-18 gm% 8.6 8.5 7.7 14.7
TLC 4.0-11.0 thou/µl 13.8 13.3 11.7 5.8
NEUTRO. 50-70% 70 70 70 70
LYMPHO. 20-45% 21 21 23 23
MONO. 2-10% 4 4 2 2
EOSINO. 1-6% 2 2 2 2
THROMBO. 1.5-4.0 Lakh/µL 2.74 2.74 3.85 3.85
Na+ 135-145mEq/L 138 143 136 136
K+ 3.5-5.2mEq/L 5.1 5.2 4.0 4.0
Cl- 95-105mEq/L 105 103 105 105
CREATININE 0.6-1.2 mg% 1.1 0.3 0.6 0.6
UREA 10-50 mg% 24 13 12 12
LABORATORY INVESTIGATIONS(1)
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INVESTIGATION NORMAL RANGE
D1 D3 D7 D14
Ca+2 8.6-10.2 mg/dl 8.8 6.3 6.8 9.2
SGOT 2 – 40 U/L 44 42 44 85
SGPT 2 – 41 U/L 44 40 43 72
ALP 40 – 129 U/L 122 122 122 122
Billrubin D 0.0 – 0.3 mg% 0.3 0.3 0.3 0.3
Billrubin T 0.2 – 1 mg/dl 0.7 0.7 0.7 0.7
Total protein 6.4 – 8.3 gm/dl 5.1 4 4.1 6.4
Albumin 3.4 – 4.8 gm/dl 2.7 2.6 1.8 3.4
Globulin 2 – 4.1 gm/dl 2.4 2.3 2.3 3.1
LABORATORY INVESTIGATIONS(2)
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DIAGNOSIS
ACUTE MENINGOENCEPHALITIS SEIZURES(GTCS)
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ROA DRUG D1 2 3 4 5 6 7 8 9 10 11 12 13
I.V PHENYTOIN(72 mg/OD)
I.V Na.VALPROATE (90 mg/BD)
I.V PHENOBARBITONE(45 mg/OD)
P.O PHENYTOIN(30 mg/OD)
P.O Na.VALPROATE (250 mg/TID)
I.V CEFTRIAXONE (450 mg/BD)
I.V ACYCLOVIR(90 mg/TID)
MEDICATION CHART(1)
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ROA DRUG D1 2 3 4 5 6 7 8 9 10 11 12 13
I.V PIPERICILLIN(4 gm) +TAZOBACTAM(0.5 gm)-I.MOD
I.V VANCOMYCIN(180 mg/QID)
I.V AMIKACIN(150 mg/OD)
I.V PANTOPRAZOLE(9 mg/BD)
P.O SYP.ACETAMINOPHEN(125 mg/QID)
P.O SYP.CALCIMAX(5 ml/OD)
P.O SYP.LACTULOSE(15 ml/OD)
MEDICATION CHART(2)
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PHARMACEUTICAL ISSUES
1.CONTRAINDICATION:CEFTRIAXONE is contraindicated in patient with hypoalbuminemia
• MANAGEMENT- Ceftriaxone can be substituted with cefotaxime(50 mg/kg/day)
- (REF: NICE GUIDE LINES-2006)
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PHARMACEUTICAL ISSUES
2.CONTRAINDICATION:-Pantoprazole is contraindicated in children
• MANAGEMENT -Pantoprazole can be substituted with
Omeprazole(6mg/day)
(Reference: BNF for children-2006)
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2.INAPPROPRIATE DOSE :
DRUG REC. DOSE/FREQ. PRES. DOSE/FREQ.
AMIKACIN 105mg/day 150mg/day
VANCOMYCIN 315mg/day 600mg/day
CEFTRIAXONE 720mg/day 900mg/day
PHENYTOIN 45mg/day 30mg/day
LACTULOSE 4mg/day 12mg/day
(Reference:BNF for children-2006)
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3.INAPPROPRIATE FREQUENCY :
DRUG REC. FREQ. PRES. FREQ.
Na. VALPROATE o. d. b. d.
(Reference:BNF for children-2006)
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THANK U
THANK U
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PHENYTOIN
• REC. DOSE• 2.5mg × 2 ×7Kg= 35mg/day
• PRES. DOSE .• 30 mg/day
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AMIKACIN• REC.DOSE.7.5mg×2×7kg=105mg/day• PRES.DOSE=150mg/day
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VANCOMYCIN• REC.DOSE. 15mg×7kg×3=315mg/day• PRES.DOSE.600mg/day
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CALCIMAX(5ml):
1. CALCIUM CARBONATE :625 mg2. VITAMINE D3 :200 IU3. MAGNESIUM HYDROXIDE :180 mg4. ZINC GLUCONATE :14 mg