Fever and Seizure in child

Age: ‍ ‍monthsyears old

Gender: ‍malefemale



HISTORY:

Presents for an episode of seizures that occurred ‍ ‍days ago

Onset was ‍gradualsudden, while ‍, preceded by ‍

Lasted for ‍ ‍secminhoursan unclear duration, ‍witnessed byunwitnessed

Described as ‍generalizedpartial ‍jerking movementstonic-clonicabsencemyoclonicatonic, with ‍normalalteredloss of consciousness

Recovery was ‍fastslow with confusion

Number of seizure episode in last 24 hours: ‍123

Peak temperature recorded: ‍° ‍not measuredparental estimationoralrectal

Associated injury: ‍noneheadneck ‍

Alleviating factors: ‍noneacetaminophenibuprofen, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍foaming at the mouth

‍tongue biting

‍incontinence

‍cyanosis

‍residual neurologic symptoms

‍fatigue

‍irritability

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍

‍dizziness

‍memory loss

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍runny nose, ‍clearcolored

‍sore throat

‍shortness of breath

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍body ache

‍fatigue

‍lethargy

‍irritability

‍rash

‍decrease in fluid intake

‍decrease in urine ouput

‍decrease in appetite

‍diarrhea, ‍ episodes ‍per day, ‍

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍dysuria

‍frequency

‍foul-smelling urine

‍flank pain



Contributing factors:

‍premature birth

‍daycare

‍similar symptoms in close contacts

no history of: ‍febrile seizures, ‍epilepsy, ‍immunodeficiency

no use of: ‍recent antibiotics

no family history of: ‍febrile seizures, ‍epilepsy



Vaccination status: ‍up-to-dateincompleteunvaccinated





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: fontanelles ‍soft, ‍normocephalic

Eyes: conjunctiva/sclera ‍normalinjection, lids/lashes ‍normalerythema, ‍PERRL, extraocular movements ‍intact, red reflex ‍present, corneal light reflex ‍symmetrical, fix and follow test ‍intact

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, ‍nasal flaring, discharge ‍clear, ‍

Throat: ‍normal, ‍palate intact, ‍redness

Neck: ‍normal, ‍lymphadenopathy, ‍nuchal rigidity, ‍torticollis, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Extremities: ‍normal inspection, ‍joints ‍normal, ‍limited ROM, ‍normal spine, Barlow ‍negative, Ortolani ‍negative, ‍normal pulses, cap refill ‍< 3> 3 sec

Skin: ‍rashlesions on ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍grossly intact, overall motricity ‍normal for agelimb weakness, muscle tone ‍normal for age, gait ‍appropriate for age, reflexes ‍intact 2+

Mental status: ‍alert, ‍, reactive to ‍





ASSESSMENT:

‍Simple febrile seizure ‍likelysuspectedpossible

DDx: simple febrile seizure, complex febrile seizure, CNS infection, electrolyte imbalance, postictal state, epilepsy, drug intoxication, toxin exposure, shaken baby syndrome, intracranial hemorrhage, brain tumor, hypoglycemia, inborn errors of metabolism, autoimmune encephalitis, vaccine reaction





PLAN:

Investigations:

- Blood work: ‍CBC, ‍creatinine, ‍electrolytes, ‍glucose, ‍calcium, ‍magnesium, ‍CRP, ‍blood culture

- Urinalysis, Urine culture

- Neuro and vital signs monitoring q1H for 4 hours

- CT scan of the brain if focal seizure, abnormal neurologic exam, or no return to baseline

- Lumbar puncture if meningitis is suspected

- EEG

Treatments:

- ‍Acetaminophen

- ‍Ibuprofen

- ‍Anticonvulsants

- Encourage hydration

- Antibiotics

Further care:

- Referral to pediatrician if atypical febrile seizure

- Follow-up in ‍ ‍hoursdays

- Return if fever persists for more than 3 days or if condition worsens

- Referral to ER if status epilepticus, severe headache, stiff neck, or other signs of serious illness occur