| QUIZ: 4 years old boy with seizures *solved* |
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| Thursday, 19 November 2009 15:50 |
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Case description: 4 years old boy is brought to A&E after an episode of seizures. He never had seizures before... The boy was born healthy on time, without any perinatal complications. He has been irritable for some days and did not want to play, said that his tummy and bones hurt. He have been vomiting quite often, while defecation acts were rare. Initially the parents thought the condition was transient and caused by the new family situation where they have moved into a new house, which is being renovated so they have little free time for the child.
QUIZ questions: What should we suspect? Which tests should be ordered?
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Comments
I'll post the CBC and glucose levels tomorrow (don't have them on me)
and which biochemistry testes do you have in mind izolda17?
Is the pain felt definitely in the bones, not muscles or joints?
Was the child playing near the materials used for renovation?
Are the parents feeling alright?
Where and how was the child playing? Did he make up any new games with his friends?
Was the diet changed?
AlAT 21
AspAT 18
Yes, the pain is within the bones
The child was running in the house, he played with different things sometimes
The parents are completely healthy
No change in diet
Could he have access to any drugs? Does he have a fever? Could he have access to any chemical substances, for example, detergents used by the parents for cleaning?
After the incident the parents realized it might be something serious. The house is still a mess, and the parents admitted the child was roaming freely around the house during the renovation
I should have given the answer yesterday, I'll post it in the evening, in the meanwhile think, you're very clos
Is the child reddish? Sweating?
What's the pulse like? Blood pressure?
Any abnormalities in ECG, if it was taken
Is anything striking during the observation of the child
The rate of breathing, any difficulties breathing? oxygenation? the volume of breaths?
Acid base balance, if it was taken
we should suspect lead poisoning, the default test is measuring lead levels in the blood.
Procedure: the therapy should be started right away!
--> hospitalization , chelation, Ca EDTA, sustaining a good dialysis (EDTA is excreted through the kidneys) careful not to over hydrate (it would worsen the encephalopathy) low fat diet with high amounts of vitamin C. calcium, iron which delays the absorption of lead into the bloodstream and increases its excretion from the body.
The child was probably poisoned by inhaling the lead vapors created by the removal of old paint from the walls (unfortunately there are still paints containing lead)
We should measure lead levels in the blood of the parents as well.
Thank you all for participation. You made a good assumption about the poisoning of some sort :-)
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