Clinical reasoning: A 68-year-old man with a first presentation of status epilepticus.
A 64-year-old man with transfusion-dependent myelodysplastic syndrome (MDS), hypertension, chronic obstructive pulmonary disease, hypothyroidism, blindness from treated syphilitic chorioretinitis, and no prior seizure history presented in generalized status epilepticus. His daily home medication regimen included prednisone 20 mg (chronic therapy for MDS), diltiazem 120 mg, digoxin 250 μg, tiotropium 80 μg, and levothyroxine 112 μg. On admission he was febrile to 39.9 °C and in atrial fibrillation with rapid ventricular rate. Initial hematologic profile showed 11,910 leukocytes/mm(3) (12% immature forms, 46% neutrophils, 32% lymphocytes), hematocrit of 30.8%, and platelet count of 215,000/mm(3), with an otherwise normal serum chemistry.
From the Department of Neurology, Johns Hopkins University, Baltimore, MD.
Logan
L
Schneider
John C
JC
Probasco
Scott D
SD
Newsome
D000368:Aged; D004077:Digoxin / Q000627:therapeutic use; D004110:Diltiazem / Q000627:therapeutic use; D006801:Humans; D008297:Male; D012307:Risk Factors; D012602:Scopolamine Derivatives / Q000627:therapeutic use; D013226:Status Epilepticus / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D000069447:Tiotropium Bromide
D012602:Scopolamine Derivatives; D004077:Digoxin; D004110:Diltiazem; D000069447:Tiotropium Bromide