Pediatric emergency medicine trisk 1436 1436
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indicated. Normal glucose levels should not necessarily be used to exclude
hypoglycemia as the seizure cause as secondary stress hyperglycemia may occur
over time as the seizure progresses. Hyponatremia is a relatively common cause
of seizures in infants, so a bedside rapid sodium test should be performed.
A febrile seizure is defined as a seizure caused by a fever, but this is a
diagnosis of exclusion. While the formal definition of the International League
Against Epilepsy considers age range for febrile seizures to be 1 month to 7
years, most of the published data and PEM approach are limited to those 6
months to 5 years of age. Caution should be used in labeling someone as having a
febrile seizure outside of this age range. Other infectious etiologies that present
with a fever and can be the direct cause of a seizure (e.g., meningitis) must first
be ruled out clinically. Routine performance of a lumbar puncture (LP) for
patients with either simple or complex febrile seizure is not required (see
Chapters 31 Fever and 94 Infectious Disease Emergencies ) but rather is based on
clinical findings. Furthermore, infections not involving the CNS may still be the
cause of the seizure through the elaboration of fever and inflammatory mediators.
Presence of fever and/or an elevated white blood cell (WBC) count may direct
one to look for a potential infectious cause, yet stress response with peripheral
leukocytosis occurs in up to a quarter of children with generalized seizures. Blood
cultures should be limited to those patients at risk for bacteremia. Urinalysis and
chest radiographs can also be used to confirm a source of infection.
