Episode 933: Benign Convulsions with Gastroenteritis
Release Date: 12/02/2024
Carepoint Journal Club: Trauma Discussion
Emergency Medical Minute
Carepoint Journal Club is a quarterly series with discussions about a medical topic, brought to you by Carepoint's Emergency Physicians.
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info_outlineContributor: Alec Coston MD
Educational Pearls:
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Causes of seizures in a fairly well-appearing child with diarrhea:
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Electrolyte abnormalities: hypocalcemia, hyponatremia
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Also hyperkalemia which causes arrhythmias and syncope - can appear like seizures
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Hypoglycemia
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If the child has diarrhea and appears very sick, differential diagnosis may include:
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Hemolytic uremic syndrome (HUS):
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simultaneous occurrence of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury
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Typically caused by Shiga-like toxin producing Escherichia coli (also known as EHEC, or enterohemorragic E. coli)
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One of the main causes of acute kidney injury in children
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Toxic ingestions such as salicylates, lead, or iron
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In this case, the child had a seizure but appeared well and was afebrile:
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Consult with neurology led to a diagnosis of benign convulsions with mild gastroenteritis (CwG)
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First identified in 1982 in Japan
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Viral gastroenteritis with diarrhea and convulsions but does not include fever, severe dehydration, or electrolyte abnormalities
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Uncommon illness caused by rotavirus and norovirus pathogens
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Criteria for discharge is similar to a febrile seizure - the patient had one seizure that lasted less than 15 minutes and he quickly returned to his baseline, so he was able to be safely discharged home
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This diagnosis does not predispose him to epilepsy later in life
References
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Lee YS, Lee GH, Kwon YS. Update on benign convulsions with mild gastroenteritis. Clin Exp Pediatr. 2022 Oct;65(10):469-475. doi: 10.3345/cep.2021.00997. Epub 2021 Dec 27. PMID: 34961297; PMCID: PMC9561189.
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Mauritz M, Hirsch LJ, Camfield P, et al. Acute symptomatic seizures: an educational, evidence-based review. Epileptic Disorders. 2200;1(1). doi:https://doi.org/10.1684/epd.2021.1376
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Noris, Marina*; Remuzzi, Giuseppe*, †. Hemolytic Uremic Syndrome. Journal of the American Society of Nephrology 16(4):p 1035-1050, April 2005. | DOI: 10.1681/ASN.2004100861
Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3
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