Pediatric emergency medicine trisk 1437 1437
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FIGURE 72.1 Diagnostic approach to seizures. The most common causes are in bold type.
An LP with analysis of the cerebrospinal fluid (CSF) is the only way to make
the diagnosis of meningitis and should be performed when meningitis is being
considered. An elevated CSF protein, CSF pleocytosis, and a low CSF glucose
level are all suggestive of CNS infection. CSF cultures, Gram stain, latex studies,
and polymerase chain reaction may identify a specific agent. Ideally, CSF
cultures should be obtained before antibiotic therapy is initiated. However, in the
critically ill or unstable patient, antibiotics should not be withheld until an LP is
performed. Furthermore, in cases in which a potential metabolic disease is being
considered, CSF lactate, pyruvate, and/or amino acid level determinations can be
used to diagnose a specific metabolic disorder. In these cases, it is often helpful to
