A 55 year-old woman was admitted to our emergency department due to her first episode of seizure. A generalized tonic colonic seizure occurred 30 min. before her arrival and lasted for 3 minutes followed by a 20 minute postictal period. On admission to ED, she was alert with complaints of chest discomfort and dyspnea. She had a history of breast cancer for which had undergone a surgery 5 months ago followed by a 2 month course of chemotherapy. She also was a known case of hypertension and hypothyroidism. Levothyroxine, levothyronine, furosemide, hydrochlorothiazide, sertraline, clonazepam, buspirone, triamterene-H and dimenhydrinate were the drugs that she was on but not taking regularly. On admission to ED she had axillary temperature of 36.5C, 14/min respiratory rate, 62/min pulse rate and 110/70 mmHg blood pressure, O2sat=96% in room air and blood sugar glucometer was 110mg/dl. On laboratory examination, Na=129mEq/L, K=2.5 mEq/L, Ca=10 mg/dl, P=3.1 mg/dl and Mg=2.6 mEq/L were reported and also in ABG, PH=7.77, PCO2=27 mmHg and HCO3=39.7mEq/L were seen. Emergency computed tomography of the brain was normal. In ECG she had obvious QT prolongation () which progressed to bigeminy PVC (). In the ED, she had a seizure again accompanied with polymorphic ventricular tachycardia (VT) that was cardioverted via 100 joules unsynchronized biphasic shock. Normal saline (0.9%) infusion was started to correct hyponatremia. Intravenous potassium replacement was initiated to correct hypokalemia and reverse the intracellular shift of hydrogen ions and reduce cellular acidosis as well as enhance HCO3excretion in the urine. Spironolactone was then administrated due to diagnosis of saline-resistant metabolic alkalosis to reduce mineralocorticoid activity. She was admitted to CCU for the adjustment of her drugs and was discharged 4 days later.