22/37

8/26/93      IPN  /Intern Transfer Note

S. Speken is a 23 year old white male with history of Crohn's Disease as an
adolescent - panic disorder with ?recent symptoms of depression who was 
admitted 8/21 for tonic - clonic seizures (witnessed by 10 year old sister)
thought to be secondary to elavil toxicity since patient was on elavil for
treatment of depression.   He denied BDZ (Benzodiazepine) use originally
but Tox(icology) screen revealed both BDZ (Benzodiazepine) & elavil &
he was transferred to ICU for management of acute BDZ withdrawal.
The patient was being treated by psychiatrist father with Xanax for panic
disorder.  he then began to see Dr. Quen for psychiatric condition &
was given Elavil 60mg QHS  2 days Prior to Admission began feeling
lightheaded & dizzy & was given bethanacol by father.  He fainted & had
seizure with 10 minute postictal period, 2 days after feeling lightheaded.

Click here for image
Click here for previous page

In ER patient was orthostatic, tachycardic, & afebrile with (?prolonged
.1) QRS complex. Admitted to floor with elavil tox(icity). Work/Up
head Ct (scan) negative.
Patient became disoriented, confused, anxious began hallucinating
was Hypertensive & tachycardic & diagnosis of Benzodiazepine
withdrawal made.  Patient was on 1:1 & Ativan 2 mg q 4 (hours) & still
became increasingly agitated with delirium.  Then transferred to ICU
Past Medical History - as above
Allergies - Immodium
Meds     elavil 60mg QHS at home
              Xanax - ?amount
Family History of panic disorder in paternal grandfather
Social History - recent college graduate. lives at home

Click here for image
Click here for previous page

Physical Exam on admission (? to ICU significant) for facial abrasions
after seizure
neuro - oriented to name, waxing & waning consciousness
speech nonsensical, tangential, positive hallucinations,
non focal

Click here for image
Click here for previous page
Click here for next page
Click here for beginning of chart