Hot Seat #168: The Toddler who SeizedPosted on: March 21, 2021, by : Dennis Ren
2-year-old unimmunized male presents after seizure at home. Per parent’s report, the seizure lasted about 30 seconds and self-resolved. The episode was described as generalized shaking of the bilateral upper and lower extremities with eye blinking.
Mother reports that the patient had a fever which started earlier today and has been less energetic since it started. Continues to drink without difficulty. Denies respiratory symptoms, vomiting, diarrhea, rash. Denies sick contacts or recent travel.
Constitutional: +fever, decreased energy
HEENT: Denies congestion, rhinorrhea
RESP: Denies SOB, cough
Cardiovascular: Denies peripheral edema
GI: Denies vomiting, diarrhea
GU: Normal urine output
- Born full term.
- No past medical or surgical history.
- Unimmunized by choice.
- Does not take any medications.
FamHx: No history of seizures
Social: Lives with parents. No medications at home
Vitals: T: 38.4 C HR: 145 RR: 38 BP: 97/75 O2: 99% on room air
General: Alert, appropriate for age.
Skin: Warm, dry, intact, no rash
Neck: Supple, no LAD
Eyes: PERRL, EOMI, normal conjunctiva
Ears, Nose, Mouth, and Throat: Moist oral mucosa. No pharyngeal erythema or exudates. TMs clear
Cardiovascular: Regular rate and rhythm. No murmurs. No rubs. No gallops. <2 second capillary refill
Respiratory: CTAB. Non-labored respirations
GI: Soft, nontender, non-distended.
GU: Circumcised. No diaper rash.
MSK: No swelling. No tenderness. Moves all extremities
Neurological: Alert. Symmetric facies. Normal motor and coordination observed.
While in the emergency department, he has another witnessed seizure with generalized shaking lasting less than a minute and self resolves. He is sleepy afterwards.
Following the lab draw, the patient’s mental status returns to baseline. Just prior to consenting the family for the LP, you get a call from lab that the blood sample needs to be repeated. After relaying this to the family, they decide that they want nothing else done (no repeat labs, no LP).
After a thorough discussion, family continues to refuse further workup. The child remains at their baseline. You let the parent know that you would like to admit the child for observation to the hospital but need to perform a COVID test. The parent becomes more upset and threatens to leave.
After discussion with the social worker, charge MD, charge RN, the parent agrees to labs and admission to the neurology service as a COVID PUI.
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