Diagnostic Dilemma

Fever with multiple convulsions

A 2 month old boy born of non-consanguineous marriage presents with fever and cough of 3 days and multiple episodes of generalized tonic clonic convulsions in past 2 days. The child has 6-7 episodes of seizures in a day, each lasting for few minutes without any post ictal drowsiness. There is no lethargy refusal of feeds. He is on exclusive breast feeds and milestones are normal. On examination, the child has respiratory rate of 48/min and heart rate of 100/min. There are no meningeal signs and anterior fontanelle is normal. CNS system is normal. On respiratory system the child has bilateral rhonchi. There is no hepatosplenomegaly and heart sounds are normal.

Does the child have meningitis?
Expert Opinion :
Though this child does have fever suggesting infection, the child is not lethargic and does not have refusal of feeds. Also though the child has seizures, he does not have post ictal drowsiness suggesting that infection does not seem to be in the brain. Thus infection as a cause of seizures seems unlikely. Multiple episodes of seizures with normal sensorium suggest a metabolic cause or seizure disorder. At 2 months of age, common metabolic problems are hypoglycemia and hypocalcemia. Hypoglycemia would present as early morning seizures, thus it seems unlikely. Hypocalcemia can occur if the child is deficient in calcium and vitamin D. Since child is on exclusive breast feeds, one should rule out calcium and vitamin D deficiency in the mother. The infection seems to be respiratory in the child with cough, increased respiratory rate and rhonchi. Increased respiratory rate may cause washout and respiratory alkalosis that can precipitate latent hypocalcemia and lead to seizures. Thus, meningitis seems unlikely in the child and one should rule out hypocalcemia. In this child CSF examination was normal and serum ionic calcium was low (0.5 mg/dl) with elevated serum alkaline phosphatase suggestive of vitamin D deficiency.
Answer Discussion :
Ilene Z Coopersmith
yes possibly
4 months ago
does not look like Meningities.Child could have Hypocalaemic seizer
4 months ago

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