An 18-month-old is brought in with a generalized seizure and a temperature of 39°C. He has no history of epilepsy or previous seizures.

Question: What would you do next?

Answer

An 18-month-old is brought in with a generalized seizure and a temperature of 39°C. He has no history of epilepsy or previous seizures.

Question: What would you do next?

Answer: You would:

  • Use the ABC approach
  • Assess with AVPU scale
  • Check temperature (febrile convulsion?)
  • Check glucose or treat anyway if no measurement available
  • Investigate causes
  • Treat:
    • ABC, oxygen
    • If blood glucose <2.5 mmol/l give 5 ml/kg 10% dextrose
    • If fever, unwrap the child (and give paracetamol)

Febrile convulsions are a diagnosis of exclusion.

Fig 1 describes the treatment of convulsions.

To treat convulsions:

ETAT+/WHO 2013 recommendations:

  • Convulsion >5 minutes or 3rd convulsion within 2 hrs: Manage ABCD and ensure hypoglycaemia is treated at all steps
  • First Rx: Diazepam 0.5 mg/kg PR or 0.3 mg/kg IV
  • If seizure continues for 5 minutes, repeat rectal 0.5 mg/kg /IV 0.3 mg/kg diazepam once only
  • If seizure continues for 15 minutes:
    • Phenobarbitone 15 mg/kg IM/IO (not if on PB already) or
    • Phenytoin 20 mg/kg IV/IO over 20 minutes
  • If seizure continues for further 20 minutes and only if resources allow, consider rapid sequence induction with thiopentone

Fig 1 Treatment of convulsions