Archive for November, 2009

A case of Uncontrollable Laughter!

So yes, I know, it has been a while, but sometimes you have to wait for just the right case. Oh sure, I have had lots of interesting cases since I have been on the floor, but to be perfectally honest, they have all been pretty sad, or just made me angery. I wanted to wait for something a little lighter to write about, well, here it is.

I was on call last night, and it was one of those nights when you knew you were not going to get any sleep. Why? Because all the crazy shit happens after midnight. I mean, I had been at work since 6am Sunday morning and it was quiet as a church mouse..but as soon as the sun goes down, that’s when kids blood sugars decide to sky rocket, lines decide to get plugged up, ect.

Well, I had just laid back down at 3am when my pager goes off. It is a text page saying that there was a consult in the ED. I go ask the nurses about it because my senior was no where to be found. They tell me that the kid has got a case of uncontrollable laughter.  Odd I think, but I make my way down to the ED to meet this patient.

As I walk in, there was this little seven year old boy who could not stop laughing. He had been laughing like that for the past two days. Just non stop. It was like one of those Batman episodes where the Joker was the villain of the day, and he had some how poisoned this child with his laughing gas. So, I get the story. Without going into too much detail, this is a little boy who has cerebral palsy and an underlying seizure disorder. He had been in his normal state of health until about ten days ago when he got the flu. He was given the flu shot, and a couple of days later the flu medication.

Here is the “funny” thing about the flu medication. First, it lowers seizure thresholds and has seizures and delerium as a side affect. Anywho, after getting the story from the parents…I leave the room puzzled because I have absolutely no idea what to do for this patient. All his labs had come back normal. No sign of infection, He was eating, pooping, and peeing alright. His vitals signs were normal, he just could not stop laughing.  So, I gave him some ativan to calm him down, and well, after the shot, he was fine. We ended up admitting him for observation, and he went home the same time I did later today. The nurses were a little dissapointed that he had stopped laughing by the time he came to the floor. They were very curious. So was I actually. I mean, this might be the oddest case I have had. Uncontrollable Laughter. I did some reading. For those of you at home who are interested…look up Gelastic Seizures. I probably will never see another case again.

Also, even if I think it might have been a waste of money for that family who also had two little kids at home, to stay the eight hours in the hospital. I think it was a good thing that we admitted him. Observation admissions cost the family less money than real ones.


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