Abstracts

Rationale: Though several studies have examined electrolyte and glucose abnormalities in mixed groups of pediatric and adult patients with febrile or non-febrile, recurrent or new onset seizures, there has not been a comprehensive prospective evaluation done in a large pediatric population. We have prospectively evaluated the frequency of electrolyte and glucose abnormalities in the immediate evaluation of children with new onset afebrile seizure. Methods: Prospective data were obtained from a mandated critical care pathway. One thousand four hundred sixty five patients presented with new onset seizures between 2001 and 2008. Electrolytes abnormalities were screened for different age groups (0 < 6 months, 6-24 months and > 2 years to 18 years) and predefined set values were assigned for each of the electrolytes and glucose results. Results: From our database, 1465 patients presented with new onset afebrile seizures ( 0 < 6 months of age = 222; 6-24 months = 347; >2 years = 896). Those with significant results are mentioned. Of the 1465 patients, 25 % (n= 374) had abnormal sodium (Na). Of the 25% abnormalites, 4.2% had severe hyponatremia. Twenty one percent of the total abnormal Na at 0 to < 6 months of age have severe hyponatremia. Fifty five percent (n=209) had mild hyponatremia with no significant difference in age groups. Out of the 1465, 17% (n =257) had abnormal potassium. Mild hyperkalemia was seen in 62% (n = 161) of the 257 patients. Of the total abnormal potassium at 0 to < 6 months (n =85), 89 % had mild hyperkalemia. Mild hypokalemia was seen in 29% (n=75) of the 257 patients. Minimal patients had severe hyper or hypokalemia. Five percent (n = 80) had abnormal calcium. Mild hypocalcemia occurred more at age > 2 years (63% at a total of 24 abnormal) and mild hypercalcemia was seen in greater frequency at the 0 to < 6 months (74% at a total of 31 patients). Five percent (n = 85) had abnormal phosphate values while eight percent had abnormal chloride values. For glucose, 22 % (n = 326) had abnormal glucose with hypoglycemia seen more in 0-<6 months and hyperglycemia seen more in >2 years old. Conclusions: Based on the data obtained, severe hyponatremia, mild hyprekalemia, mild hypercalcemia and mild hypoglycemia were seen more in the children younger than 6 months. Mild hyperkalemia and hyperglycemia were seen in children older than 2 years although this may be secondary to some hemolysis during blood draw and stress during the seizures respectively. Children younger than 6 months were more predisposed to laboratory abnormalities.