Fever and seizure (Febrile Seizure-FC)
FC refers to seizures that occur between the ages of 6 to 60 months (peak age: 12 to 18 months) following a temperature of 38 degrees or more.
In order to use the FC semester, you must:
CNS infection
Metabolic imbalance
History of previous febrile seizures
do not exist
Up to 48 hours after the onset of fever, if there is no other reason for the seizure, FC term can be used.
In 20% of FC cases, first seizures and then fever are seen in patients.
Two types of FC that we see at the bedside:
1- Simple FC:
In this type of FC, the seizure is generalized, lasts less than 15 minutes, occurs once in 24 hours and does not recur. The post-ictal phase in this type is short and after a few minutes the patient returns to baseline. returns
2-Complex FC:
In this type of FC, seizures are focal, last more than 15 minutes, and recur in 24 hours.
In which patients is it possible for febrile seizures to repeat? (Table 611-5 Nelson 2020)
Major criteria:
Age under one year
Duration of fever less than 24 hours
Fever 38-39 degrees Celsius
Minor Criteria:
Family history of febrile seizures
Family history of epilepsy
FC Complex
Attending day care centers
male sex
Low serum sodium at the time of seizure
Without risk factor: risk of recurrence 12%
1 risk factor: 25-50% risk of recurrence
2. Risk factor: 50-59% risk of recurrence
3 or more: 73-100% risk of recurrence
Investigating the risk factors of late epilepsy in FC patients :(Table 611-6 Nelson 2020)
Simple FC: 1% risk of future epilepsy
Recurring FC: 4%
Complex FC (more than 15 minutes or repeated in 24 hours): 6%
Fever less than one hour before fever and seizure: 11%
Family history of epilepsy: 18%
FC complex (focal): 29%
Neurodevelopmental disorders: 33%
Imaging in FC:
In children with the first episode of FC, CT scan or MRI is not recommended.
In cases of complex FC, depending on the case, EEG and imaging will be indicated.
Order FC
Imp:Febrile Seizure (FC)
Condition: Not good/not bad/urgent/emergent
Diet: NPO
Please:
1. IV line fixed
2. Check V/S as routine
3. Cardiac monitoring and pulse oximetry
4. Check CBC-diff-BUN-Cr-Na-K-Ca-P-Mg-ESR-CRP-VBG-U/A-U/C-B/C-S/E (in case of diarrhea)-FBS
5. Bs Glucometery stat
6.Amp Apotel (10×Kg)mg IV If T>38 Q4-6h
The use of antipyretics reduces the patient’s discomfort but does not reduce the risk of recurrence of febrile seizures.
7. CXR (if indicated)
8. If seizure:
Lateral position
O2 therapy with face mask
Amp Diazepam 0.2mg/kg IV Slow injection
Treatment with BZDs should be started when 5 minutes have passed since the seizure (like other types of seizures).
Intravenous diazepam should be injected slowly over 2-5 minutes.
If you don’t have an IV:
Rectal diazepam in the form of:
2-5 years: 0.5mg/kg
5-12 years: 0.3mg/kg
More than 12 years: 0.2mg/kg
In cases where the rectal form of diazepam is not available, diazepam ampoule can be injected through a feeding tube placed 4 to 6 cm into the rectum.
If the above are not available, intramuscular midazolam with a dose of:
Amp Midazolam 0.2mg/kg IM (Max=5-10mg)
Lorazepam ampoules are not commonly available in Iranian medical centers.
9. EEG
In cases where the risk of the possibility of collapse in the future is high (Table 611-6)
In these cases, EEG is used to determine the type of epilepsy, not to predict its recurrence
EEG is not recommended as a routine evaluation in children with a first febrile seizure, who otherwise have a normal neurologic examination.
Even if EEG is abnormal, it is not predictive of future recurrence of FC or epilepsy.
10. LP obtaining consent
In all infants under 6 months with FC manifestations
Children in a bad mood
Patients with alarming symptoms
11. Serum D/W 5%
According to the patient’s condition
12. Visiting the respected pediatrician or transfer to the pediatric department
Continued in the next post
Children
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