This case presentation discusses a 9-month-old male child who presented with fever for 2 days and 4-5 episodes of seizures. Laboratory investigations revealed acute meningoencephalitis. The child was diagnosed with acute meningoencephalitis and seizures. He was treated with intravenous antiepileptics, antibiotics including acyclovir, pantoprazole, and supportive medications. Some issues with the treatment plan included contraindications, inappropriate dosing, and frequency of medications. The presentation highlights the diagnosis and management of this case of acute meningoencephalitis with seizures in a child.

1. CASE PRESENTATION ON
ACUTE MENINGOENCEPHALITIS
WITH SEIZURES
Presented by
NIKHIL SINGH
M.PHARM
NIPER,HAJIPUR

2. 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 worldwide
Symptoms
• Fever
• Headache
• Behavioral changes
• Altered level of consciousness
• Seizures

3. 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

4. MENINGOENCEPHALITIS
• MENINGOENCEPHALITIS:- Inflammation in brain
membrane.
Brain is covered by three layers
1)Pia-matter (innermost layer)
2)Arachnoid-matter (middle layer)
3)Dura-matter (outer layer)

5. OBJECTIVE FINDINGS
• AGE : 9 MONTHS
• SEX : MALE
• WEIGHT : 7Kg
• BP : 110/70mm Hg
• HR : 129/min
• Case Reference: IGIMS, Patna, Bihar

6. CHIEF COMPLAINTS
1. FEVER × 2 DAYS
2. SEIZURES × 4 – 5 EPISODES

7. 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
LABORATORY INVESTIGATIONS(1)

8. 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)

9. DIAGNOSIS
ACUTE MENINGOENCEPHALITIS
SEIZURES(GTCS)

10. 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 PHENOBARBIT
ONE(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)

11. 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.M
OD
I.V VANCOMYCIN
(180 mg/QID)
I.V AMIKACIN(150
mg/OD)
I.V PANTOPRAZOLE(9
mg/BD)
P.O SYP.ACETAMINOP
HEN(125 mg/QID)
P.O SYP.CALCIMAX(5
ml/OD)
P.O SYP.LACTULOSE(
15 ml/OD)
MEDICATION CHART(2)

12. 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)

13. PHARMACEUTICAL ISSUES
2.CONTRAINDICATION:
-Pantoprazole is contraindicated in children
• MANAGEMENT
-Pantoprazole can be substituted with
Omeprazole(6mg/day)
(Reference: BNF for children-2006)

14. 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)

15. 3.INAPPROPRIATE FREQUENCY :
DRUG REC. FREQ. PRES. FREQ.
Na. VALPROATE o. d. b. d.
(Reference:BNF for children-2006)

16. THANK U

17. PHENYTOIN
• REC. DOSE
• 2.5mg × 2 ×7Kg= 35mg/day
• PRES. DOSE .
• 30 mg/day

18. AMIKACIN
• REC.DOSE.7.5mg×2×7kg=105mg/day
• PRES.DOSE=150mg/day

19. VANCOMYCIN
• REC.DOSE. 15mg×7kg×3=315mg/day
• PRES.DOSE.600mg/day

20. CALCIMAX(5ml):
1. CALCIUM CARBONATE :625 mg
2. VITAMINE D3 :200 IU
3. MAGNESIUM HYDROXIDE :180 mg
4. ZINC GLUCONATE :14 mg