Tonic Clonic Convulsions - Pediatric Oncall

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
I would like to bring to your attention the case of a full term baby weighing 3.2 kgs at birth with normal birth history who developed tonic clonic convulsions lasting few seconds at 14 days of age, 2 episodes in all. There was no fever or reduced feeding during or after the episodes. On examination there was no organomegaly or abnormality found on general examination regarding congenital anomaly or abnormal faeces. His random blood sugar was normal. But his serum calcium turned out to be 4mg/dl. While his serum sodium was normal, his serum potassium was 6meq. After managing for hypocalcemia ( inj. Calcium gluconate 2ml/kg iv stat and maintenance) his electrolytes were repeated. His serum calcium had improved but was still low and his serum potassium had increased over the hours to 7meq. Baby’s serum phosphate, vitamin D levels, serum alkaline phosphatase have not been done. His GBP and hemogram are also normal. The renal and liver profiles are normal. The child’s mother had an uneventful antenatal history and suffers from no known systemic illness. Mother’s serum PTH and Vitamin D levels also had not been done. The baby was on mixed top and breast-feeding since birth. After discharge from the hospital his serum calcium is 9.2mg% and serum potassium is 6meq. Can you suggest me some causes for the strange electrolyte levels and its treatment in case convulsions recur. The parents have reported them once after discharge for a brief period despite normal serum calcium levels. Please reply at the earliest..
Answer
One needs to know the phosphorus and alkaine phosphatase. Also was the mother breast feeding or was the baby on top feeds? The low calcium could be due to low calcium in the mother if the mother was breast feeding or due to top feeds if the child was not on breast feeds. The high potassium needs investigation. Rule out renal causes and adrenal causes for the same. Back to All Questions

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