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Dosing By Body Weight?

Dosing By Body Weight?. Ms KB. 29 yr female Generalised seizure 1st episode Presented to local GP run hospital. History. Tonic clonic seizure witnessed by partner Self terminated after < 10 minutes Ambulance transfer to local hospital On arrival agitated, settled following IV diazepam.

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Dosing By Body Weight?

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  1. Dosing By Body Weight?

  2. Ms KB • 29 yr female • Generalised seizure 1st episode • Presented to local GP run hospital

  3. History • Tonic clonic seizure witnessed by partner • Self terminated after < 10 minutes • Ambulance transfer to local hospital • On arrival agitated, settled following IV diazepam

  4. Past history • Fibromyalgia • Sjogren’s Syndrome • Meningococcal meningitis 1994 • Depression • Morbid Obesity

  5. Medications • Amitriptyline 50 mg QID • Panadeine Forte q 6 h • No Known Drug Allergies

  6. Background History • 3/52 dizzy spells, falls, difficulty in sentence formation • 1/52 poor balance, intermittent blurred vision • In bed for previous 48 hours • Fell as attempting to walk to lounge, hit head, generalised seizure, non responsive for 10 minutes

  7. Initial Examination • BP 135/85 mmHg, Pulse 85, 100% sat on RA • GCS 12, irrational and aggressive but no focal neurological signs • CVS, Resp, Abdo unremarkable

  8. Investigations • ECG sinus tachy 95 bpm, QRS 140 ms

  9. Treatment • Diazepam 10 mg IV • Oxygen • Transferred by road to DGH

  10. At DGH • Alert and cooperative • BP 138/77 mmHg, pulse 101 • Examination unremarkable • ECG @ 12.40 shows QRS of 120 ms • Commenced on cardiac monitoring • Head CT arranged

  11. Subsequent events • Cardiac Arrest 1345 h in toilet • Found in asystole • Cardiac output restored @1405 • Given NaHCO3 • Retrieval to Newcastle Mater ICU

  12. Mater ICU • Pulse 80 BP 140/80 mmHg • Aspiration R LL • GCS 5 • Asystolic arrest due to amitriptyline, probable hypoxic brain injury

  13. Mater ICU • Medications as taken • Amitriptyline 200 mg QID • Panadeine Forte 4 tabs q 6 h • For 5 months duration • Asystolic arrest due to amitriptyline, probable hypoxic brain injury

  14. Subsequent History • 3 days later remains intubated, eye open to voice, purposeless limb movements, does not obey commands • Extubated on day 13, sent to ward, feeding by NGT • Referral to rehab • Day 27, following one stage commands, commenced oral feeding

  15. Outcome • Day 32 discharged to rehab • Hypoxic brain injury • Discharged home to care of husband

  16. Chronic TCA poisoning

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