Page 151 - ITPS-7-2

INNOSC Theranostics and
Pharmacological Sciences From fever to seizure: A pediatric case study

viral infections, notably HHV-6 in the United States and elevated risk of future epilepsy, febrile seizures typically do
European countries, and influenza A virus in Asian regions, not impair cognition or intellect or induce neurological
commonly associated with febrile seizures. Nonetheless, dysfunction. 11,12
any substantial fever can incite a febrile seizure. 3,4
Febrile seizures are prevalent among children aged 2. Case presentation
6 months to 5 years, affecting up to 4% of this demographic. FSE represents a critical manifestation of febrile seizures,
While some children may experience a single febrile characterized by episodes lasting 30 min or more. This case
seizure, others may endure multiple occurrences during delves into a 1-year-old baby boy admitted to the pediatric
early childhood. However, the precise pathophysiology of department weighing 12 kg, presenting a 5-day history of
febrile seizures remains elusive. A hereditary predisposition fever, vomiting, cough, and a severe seizure episode lasting
exists, with 10 – 20% of first-degree relatives of affected 20 – 25 min. This seizure episode was marked by ocular
patients also experiencing febrile seizures, although the deviation, frothing of the mouth, and generalized tonic-
mode of inheritance remains undefined. 5 clonic features. Upon admission, clinical examination
revealed a temperature of 102°F, a heightened heart rate
No specific treatment exists for simple or complex
febrile seizures other than addressing underlying febrile of 162 bpm, and a respiratory rate of 24/min. Over 3 days,
illnesses. Antipyretics have not demonstrated efficacy in hematological and biochemical assessments as shown in
preventing recurrent febrile seizures. Studies examining Table 1 revealed fluctuating levels, including hemoglobin
the use of benzodiazepines as a short-term measure readings (12 – 11.8 g/dL; normal range: 11 – 15.5 g/dL);
during subsequent febrile events in patients with frequent red blood cell counts (4.7 and 4.8 million/cumm; normal
range: 4 – 5.2 million/cumm); white blood cell counts
recurrences have been conducted. Febrile status epilepticus (40.9 – 9.6 thousand cells/cumm; normal range:
(FSE), occurring in <10% of initial febrile seizures,
warrants immediate intervention using rectal diazepam 5 – 13 thousand cells/cumm); and platelet counts
or intranasal midazolam if the event exceeds 5 min. Such (3.24 and 2.19 lakhs cells/cumm; normal range:
patients face an increased risk of future episodes. 6-8 1.8 – 4.5 lakhs cells/cumm) as shown in Table 2. In addition,
electrolyte imbalances were observed with sodium levels
While most febrile seizure cases do not necessitate of 137 – 141 mmol/L (normal range: 136 – 145 mmol/L),
hospitalization or extensive intervention, prolonged potassium levels of 3.3 – 4.3 mmol/L (normal
complex febrile seizures may result in Todd’s paralysis, range: 3.5 – 5 mmol/L), and chloride levels of
which is characterized by focal weakness that typically 99 – 105 mmol/L (normal range: 95 - 105 mmol/L) as
resolves within hours to days. Notably, patients with shown in Table 3. Renal function tests reflected normal
febrile seizure status, defined as seizures lasting over blood urea nitrogen (BUN) and serum creatinine (Sr. Cr)
30 min, require immediate treatment akin to prolonged levels within standard ranges as shown in Table 4. The
seizures from other causes. It is essential to promptly diagnostic process included a magnetic resonance imaging
broaden the differential diagnosis if a patient fails to (MRI) scan that exhibited normal myelination. Treatment
regain consciousness or exhibits unexpected neurological encompassed a multidrug approach involving antibiotics
abnormalities post-seizure. 9,10 (injection ceftriaxone, injection meropenem, and injection
These cases warrant evaluation for ongoing seizure linezolid), anticonvulsants (injection levetiracetam, tablet
activity or other intracranial abnormalities, often clobazam, and syrup levetiracetam), and supportive care as
necessitating prolonged electroencephalogram (EEG) shown in Table 5. Throughout the hospital stay, the patient
studies and further investigations for potential underlying experienced varying symptoms, including high-grade fever
pathologies. Collaborative management involving spikes, vomiting, decreased cough, and cold. Adjustments
pediatricians and neurologists is essential for diagnosing to the medication regimen resulted in reduced fever spikes,
and managing febrile seizures. Patient education plays a cessation of vomiting, and the absence of new complaints.
crucial role in mitigating unnecessary emergency room Ultimately, the patient remained afebrile and active for 48 h
visits and avoiding unverified remedies. Parents should before discharge. The subjective assessment on admission
be informed about when to seek emergency care and outlined a 1-year-old male admitted to the pediatric
cautioned against using aspirin for fever management. intensive care unit due to fever, seizures, vomiting, and
The unified approach of the interprofessional team loose stools, with objective findings indicating normal
ensures comprehensive care for patients experiencing laboratory parameters. The tailored treatment approach
febrile seizures. The prognosis for most children with led to discharge upon symptom reduction and minimized
febrile seizures is favorable, with approximately 30% fever spikes. Notably, the patient had potential severe drug
experiencing subsequent seizures. While there is a slightly interactions with carbapenems, warranting caution in

Volume 7 Issue 2 (2024) 2 doi: 10.36922/itps.2735