Ext. Ukrit Uthaicharoenpong
Case Chief
4 complaint 3 hours PTA
Present illness1
day PTA hours PTA 1 1 1
11
Present illness3
hours PTA 4-5 1
Past history No underlying disease No food and drug allergic
history 6-8 2 1 Family history
Physical examination Vital
signs : BT 37.7 C, PR 11 bpm, BP 110/60 mmHg, RR 22/min 14.5 kg
a Thai girl, alertness
BW GA:
HEENT:
mildly pale conjunctivae, intact TM at right ear, impacted
cerumen at left ear, pharynx and tonsils are not injected, normal
nasal mucosa
Physical examination Heart: Lungs
normal s1s2, no murmur: clear at both lungs, no adventitious
sound Abdomen
: hyperactive bowel sound, soft, no tenderness : abrasion at
upper back, no rash, no petechiae
Skin
Physical examination Neuro
: active, no stiff neck, negative Brudzinskis sign, negative
kernigs sign,
??
Fever
with seizure 2 times 3 hours PTA Diarrhea 3 hours PTA History of
multiple febrile seizure Abrasion at upper back
??
Impression
: febrile seizure Differential diagnosis Epilepsy CNS infection
Electrolyte imbalance Trauma
CBC UA 5%
with platelet
DN/2 IV rate 70 ml/hr Ibuprofen Observe seizure, please notify
if seizure Diazepam
Record
vital signs Record body weight OD Soft diet Tepid sponge
Paracetamol Motilium ORS
admit 1-2 BT observe PICU
RBC Hb Hct MCV MCH MCHC RDW Platelet WBC Neu Lymp Mono
4.82 13.9 40.7 84.3 28.8 34.2 13.0 317000 17500 85 12 3
Na
141 K 3.79 Cl 110.8 HCO3 19
Yellow,
clear Sp. Gr. 1.010 pH 6.0 Chemical exam : negative Microscopic
exam RBC not found WBC 1-2/HPF Epith 1-2/HPF No
cast No crystal
RBC WBC Ova¶site
not found not found not found
Ceftriaxone
500 mkday
.4
Phenobarb
: loading dose IV drip (20 mkdose) :
Discharge
Phenobarb gr (30)
maintenance dose (3 mkday) bid EEG
?
Brief
(24 hr after fever onset Duration >15 min Occur more than
once in 24 hr Focal motor manifestations Abnormal neurological
examination
Typical:
not required Atypical: required EEG Toxicology screening
Assessment of electrolytes CT or MRI
If
any doubt exists about the possibility of meningitis, lumbar
puncture with examination of the CSF is indicated.
To
rule out meningitisCNS infection was suspected
When
Atypical
febrile convulsion
American
academy of pediatrics 12 18
Routine
treatment:
Search for the cause of fever Control fever (avoid excessive
clothing,
encourage fluids, tepid sponge bath, and antipyretics)
Prophylactic
anticonvulsants are not indicated for typical febrile
convulsion
Excellent
prognosis in most children Risk of recurrence: Onset < 1 y/o
or with family history: 50% Onset > 1 y/o: 30 % up to the age of
5 yr After second episode: 50 % Age > 5 y/o: near zero
Risk of epilepsy development: 1~2% in the general population
increase up to 9% when two or more risk factors are present
Risk
factors for epilepsy development:
Positive family history of epilepsy Atypical febrile convulsion
Previous abnormal development or neurological
disorder
Phenobarbital:
ineffective and may decrease cognitive function Carbamazepine:
ineffective Phenytoin: ineffective Valpronic acid: effective, but
with potential risk of fatal hepatotoxicity, thrombocytopenia, GI
disturbances, and pancretitis
Antipyretic
agents: ineffective Diazepam: effective and safe Oral or rectal
form For patients with frequent febrile convulsion
or significant parental anxiety Dose: 0.3 mg/kg q8h PO (1
mg/kg/d) for the duration of the illness (2~3 days) Side effects:
lethargy, irritable, ataxia
Objective
of this study ; to evaluate the investigations in the first
simple F.C. patient at Phamongkutkao Hospital.
The
result showed 75 patients in study, 42 % of the patients were 3
month to 1 years old. The causes of the fever were URI 34.5 % and
25 % acute diarrhea.
The
investigations were CBC (100%), lumbar puncture (94.7%),
Electrolyte (98.7%),Ca(80%) Mg(41.3%), Cr (76%), EEG (2.6 %), film
skull (8%) and CT scan brain (1.3 %)
In conculsion ; for first simple F.C. in the patients age 3
month to five years old , investigations should be considered upon
clinical indication which should be done or not done.
Nelson,
textbook of pediatrics ,
THANK YOU
