Pediatric emergency medicine trisk 1425 1425
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consciousness is impaired, can lead to hypoxia, hypercarbia, and respiratory
acidosis. Patients with impaired consciousness may be unable to protect their
airway and are at risk for aspiration. Prolonged skeletal muscle activity can lead
to lactic acidosis, rhabdomyolysis, hyperkalemia, hyperthermia, and
hypoglycemia.
ETIOLOGY
It is important to remember that a seizure does not constitute a diagnosis but is
merely a symptom of an underlying pathologic process that requires a thorough
investigation ( Table 72.1 ). Often, no underlying condition is identified, and the
diagnosis of idiopathic epilepsy is made. However, it is important not to exclude
potentially treatable causes prematurely. For instance, seizures that result from
metabolic derangements (e.g., hyponatremia, hypoglycemia) are often refractory
to anticonvulsant therapy until the abnormality is corrected. Therefore, rapid
point-of-care testing for glucose and sodium are recommended for pediatric
status. Furthermore, every effort should be made to rule out a potentially lifethreatening cause of seizures (e.g., intracranial injury or hemorrhage, meningitis,
ingestions) before a less serious diagnosis is accepted.
