Diagnostic Dilemma

Convulsions and jitteriness

A 2-month-old girl presented with recurrent episodes of tonic convulsions for 3 days lasting for 4-5 minutes without post ictal drowsiness. There is no history of fever, lethargy or refusal to feeds. She is born at full term by normal vaginal delivery with birth weight of 2 kg. She is feeding cow’s milk 1:1 dilution. She was breast fed only till Day 5 of life. She has achieved head holding and social smile. On examination, weight was 3.75 kg, anterior fontanelle was level and cry, tone and activity were good. She had beading and excessive jitteriness. Other examination findings were normal.

What is the diagnosis? How to avoid this condition?
Expert Opinion :
This child is on diluted cow’s milk. Cow’s milk is high in phosphate that can lead to hypoglycemia. Hypoglycemia can explain the jitteriness and beading and also repeated episodes of seizures in an otherwise well child. In this child serum calcium was 6mg/dl with ionic calcium of 0.6mmol/l suggestive of hypoglycemia. She responded to calcium supplements and parents were advised regarding humanizing cow’s milk.
Answer Discussion :
pijush pal
Diagnosis: Cow milk protein allergy.
Management : Exclusive breast feeding till 6 mth of age.
Avoid cow milk ( including dairy products) now and in future also.

2 years ago
Elsa Lima Teixeira
2 years ago

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