The Case Files: Febrile Pediatric Hypocalcemic Seizure

By Andrew Park, DO, MPH, & Jeremy Hunter, DO A 6-month-old boy was brought to the emergency department by his parents for seizure activity just prior to arrival. They reported that the baby had been feverish for two days, and was evaluated in a different ED. He was given Tylenol there.   He was eventually diagnosed with a viral syndrome and then discharged home. The parents reported that he had been febrile but otherwise normal since being discharged from the ED, but he began shaking his arms and appeared to be having a seizure approximately five minutes before arrival at our ED. The parents denied any previous seizure activity.   The child was placed in a treatment room for immediate evaluation of persistent seizure activity. His rectal temperature was 38.7°C on presentation, and physical exam revealed an inconsolable male infant with hypertonic upper and lower extremities. The patient’s arms were flexed approximately 45 degrees at the elbow, his fontanelle was bulging, and his head was rotated approximately 30 degrees to the left. The remainder of the physical examination was unremarkable except for mild frontal bossing.   IV access was attempted but proved difficult. During IV attempts, the patient’s mental status returned to normal, according to the parents, though they said he less active than usual. Seizure activity ceased. An intraosseous line was placed and sample obtained for laboratory analysis. A full septic workup was performed including lumbar punctur...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research