Just before midnight, a 23-year-old active-duty Marine arrived via ambulance after having 2 generalized seizures at a local health center. The man presented to the clinic complaining of a headache, feeling “sick to his stomach,” and vomiting once. Witnesses reported that each seizure lasted approximately 2 minutes, with a 2-minute interval between episodes. On ED presentation the patient appeared to be in a post-ictal state, responding to verbal stimuli but generally confused and drowsy. His initial vital signs were as follows: blood pressure, 125/72 mm Hg; heart rate, 70 beats per minute; respirations, 14 per minute; and temperature, 36.6°C (97.9°F). Oxygen saturation was 100% on a nonrebreather mask. As he recovered from the seizures, our patient became increasingly coherent and was able to provide limited information. He denied having any previous convulsions but reported a long-term history of migraines. The man “felt fine” during the afternoon, which he had spent with a large group of Marines handling explosive ordnance. During that time his unit had been exposed to temperatures in the low 90s (F), with normal humidity relative to the summer season. The patient asserted that he had consumed an adequate amount of water, given the ambient temperature and humidity, and had eaten his normal intake of food. Prior to ED arrival, EMS personnel had established intravenous access, a normal saline solution bolus had been given, and the Marine’s fingerstick blood glucose level was measured as 94 mg/dL. He remained in normal sinus rhythm and was switched to 3 L of oxygen per minute via a nasal cannula. Seizure pads were prophylactically put in place on the stretcher. Approximately 15 minutes after ED arrival the patient was coherent enough for the staff physician to perform a detailed assessment. Physical examination of all systems was normal. The patient was alert, verbally responsive, and had no unusual neurologic findings. However, just as the physician was completing the examination, the patient experienced a generalized seizure. Administration of 15 L of oxygen was immediately restarted via a nonrebreather mask, and he was given 1 mg of intravenous lorazepam (Ativan). This protocol aborted the seizure after approximately 2 minutes. The patient was transported to the radiology department, with an emergency nurse escort, for a non-contrast computed tomography scan of his head. An additional 1 mg of intravenous lorazepam was required to manage agitation during the procedure. Following the examination, our patient was returned to the emergency department without further agitation or seizure activity. The computed tomography scan was interpreted by a radiologist as normal. While the Marine was out of the department, initial laboratory results became available, revealing several abnormal values. His white blood cell (WBC) count was 26,000/mm (reference range: 3.8-11 K/mm), and creatine phosphokinase was 2151 milliunits/mL (reference range: 25-145 milliunits/mL). Urinalysis showed large amounts of blood and protein, but the urine drug screen was negative. The patient’s seizures and elevated WBC count prompted the physician to perform a lumbar puncture and order 2 g of intravenous ceftriaxone (Rocephin). Cerebral spinal fluid was positive for red and white cells, but the tap had been traumatic, making the results difficult to interpret. An internal medicine consultant ordered 1 g of phenytoin (Dilantin) and 1 g of vancomycin (Vancocin) to be administered via an intravenous line Lt. Lalon Kasuske is Division Officer (Nurse Manager), Emergency Department, US Naval Hospital, Okinawa, Japan.