A 37 years old man is found by his 15 years old son at his home fitting. He was lying on the living room sofa with jerking movement of all 4 limbs.

An ambulance is called and he is brought immediately into Resus. The paramedics arrived on the scene within 5 minutes and gained intravenous access and administered 10mg iv diazepam en-route.

On arrival in Resus he had a blood sugar of 6.7 and was continuing to have a seizure.

Q1. Describe your initial approach to the management of this patient in Resus.

After initial treatments he continues to fit. On further questioning the son reveals that his father and mother have recently separated and that his father has been on antidepressants. He states that he has been unusually low the last few days, which is why he was visiting to make sure he was fine. He has never had a seizure before and had previously been medically fit.

Q2. What further investigation may be appropriate at this time?

Q3. What could be the likely cause for the seizure?

A phenytoin infusion is started and been running for 30 mins. He has a temperature of 40.1°C. He still has some twitching movements of his limbs.

Q4. What specific treatments would you consider to start for this patient?

Q5. The ITU doctor has requested a CT head scan before the patient is taken up to ITU. Is this appropriate at this time? Give your reasoning.

He is catheterised in ED and after emptying his bladder is found to have dark coloured urine. His CK has come back as 25,500.

Q6. What is the cause for this and how would you treat it?

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case.

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