Febrile Seizures in Pediatric Patients

Study Notes

A 14-month-old girl presents with generalized tonic-clonic seizure after waking from a nap, with a history of mild rhinorrhea.
She is alert and responsive, with a temperature of 39.8°C (103.6°F).
The most appropriate next step in management is reassurance.
The patient's clinical picture is consistent with a simple febrile seizure, which is common in children aged 6 months to 6 years.
Simple febrile seizures are generalized, last less than 15 minutes, and typically occur in the context of a febrile illness.
Simple febrile seizures are generally self-limited and do not require treatment or carry a high risk for future epilepsy.
A thorough history and physical examination are essential to differentiate simple febrile seizures from complex seizures caused by viral or bacterial central nervous system infections.
A CT scan of the head is not indicated in this case, as the patient does not exhibit focal neurological signs or altered mental status.
Anticonvulsant therapy is not necessary for simple febrile seizures, as they are typically self-limited.
An EEG is not required for simple febrile seizures, as the seizure duration is less than 15 minutes in the context of a febrile illness.
A lumbar puncture is not necessary for simple febrile seizures, as the patient does not exhibit symptoms suggestive of meningitis or encephalitis.

Thyroid storm is a serious complication of hyperthyroidism.
Occurs in patients with a known diagnosis of hyperthyroidism after physiologic stress, such as infection, surgery, or trauma.
Presents with vital sign instability, mental status changes (agitation, obtundation, or coma), tremor, seizures, hyperreflexia, diaphoresis, nausea, diarrhea, and potential high-output heart failure.

Initial diagnosis of thyroid storm is made through a combination of clinical features and thyroid function testing.
Increased serum concentrations of triiodothyronine (T3) and thyroxine (T4), and a decreased concentration of thyroid-stimulating hormone (TSH) are indicators.

Supportive care is required.
Treatment of the underlying provocative stress is crucial.
Intravenous corticosteroids, beta-adrenergic blockers, propylthiouracil, and potassium iodide are used.

Blood culture can be used to diagnose bacteremia and sepsis.
Complete blood count with differential may disclose neutrophilia in the setting of pneumonia or leukocytosis in the setting of thyroid storm.
CT scan of the head is helpful for excluding intracranial mass lesions prior to performing a lumbar puncture in patients with meningitis.
Measurement of serum calcium and magnesium concentrations can help assess potential causes of hyperreflexia.

Podcast Beta