A Case Presentation on Febrile Seizures

1. Case presentation on febrile seizures
Presented by :
METI.BHARATH KUMAR
16DK1T0014
Pharm-D(Intern)

2. Demographics
• Name :xyz
• Age :9 months
• Sex:male
• Admission No:46840
• Department : pediatrics
unit : ch-2
• Date of admission :7/9/21
• Consultant physician:Dr. Ravi krishna

3. Subjective evidence
• A 9months old male child admitted in
pediatrics child unit 2 with complaints of
--fever,cough, cold sine 1 week, fever high grade
insidious onset
--seizure activity 3 episodes in the form of
uprolling of eye balls( tonic posturing of both
UL and LL, which lasts for 10minutes

4. Objective evidence
• CBP:
hb: 9.6mg/dl
wbc:47.8
rbc:4.6
plt:355

5. Assessment
• Based on subjective and objective evidence
the current condition is diagnosed as complex
( atypical) febrile seizures

6. Planning
vitals
• On examination child is
sleepy
• Pv normal
• Rr: 39/min
• Cvs: s1s2+
• Rs:BAE+
• P/A : SOFT
• CNS: TONE NORMAL
• RBS: 111mg/dl
Treatment
• Inj ceftriaxone 450mg iv bd
• Inj amikacin 100mg iv bd
• Inj phenytoin 20mg/kg/day(
180mg in 20ccNS for
20minutes)
• Tab clobazam 5mg
• Ivf
• Inj midazolam 1cc+2ccns SOS
• SYP pct PO TID
• SYP SALBUTAMOL po bd

7. Planning
vitals
• On examination child is drowsy
since yesterday and febrile
• No further seizure activity
• c/o constipation
• c/o rashes all over body
• Pv normal
• Rr: 32/min
• Bp: 90/60mmhg
• Cvs: s1s2+
• Rs:BAE+
• P/A : SOFT
• CNS: TONE NORMAL
• RBS: 117mg/dl
Treatment
• Inj ceftriaxone 450mg iv bd
• Inj amikacin 100mg iv bd
• Inj phenytoin 20mg/kg/day(
180mg in 20ccNS for
20minutes)
• Tab clobazam 5mg
• Ivf
• Inj midazolam 1cc+2ccns SOS
• SYP pct PO TID
• Syp atarax bd

8. Drug chart
s.n
o
Generic bran
d
indication dose ROA Freque
ncy
1 ceftriax
one
To reduce infection 450m
g
iv bd
2 amikaci
n
To reduce infection 100m
g
iv bd
3 phenyt
oin
To reduce seizures 180m
g
iv bd
4 clobaza
m
To reduce seizures 5mg po bd
5 midazol
am
To control seizure activity 1cc Iv sos
6 acetami
nophen
To reduce fever 3.5ml po tid
7 salbuta
mol
To control shortness of breath 3.5ml po bd
8 hydroxy
zine
atara
x
To reduce allergic reactions 3ml po bd

9. Pharmaceutical care isssues
• Drug interaction :
clobazam+midazolam: concurrent use of both
may result in increased risk of hypoventilation,
airway obstruction , dasaturation or apnea.
• ADR:
phenytoin induced constipation

10. Discussion
• A febrile seizure is a convulsion in a child
that's caused by a fever. The fever is often
from an infection. Febrile seizures occur in
young, healthy children who have normal
development and haven't had any
neurological symptoms before.
• They mostly occur in children between the
ages of 6months and 5yrs.

11. symptoms
Usually, a child having a febrile seizure shakes all
over and loses consciousness. Sometimes, the
child may get very stiff or twitch in just one
area of the body.
A child having a febrile seizure may:
• Have a fever higher than 100.4 F (38.0 C)
• Lose consciousness
• Shake or jerk the arms and legs

12. Febrile seizures are classified as simple or complex:
• Simple febrile seizures:(typical)
This most common type lasts from a few seconds to 15
minutes. Simple febrile seizures do not recur within a
24-hour period and are not specific to one part of the
body.
• Complex febrile seizures:( atypical)
This type lasts longer than 15 minutes, occurs more than
once within 24 hours or is confined to one side of your
child's body.
Rule out CNS Infection

13. Causes
Usually, a higher than normal body temperature causes febrile
seizures. Even a low-grade fever can trigger a febrile
seizure.
• Infection
The fevers that trigger febrile seizures are usually caused by a
viral infection, and less commonly by a bacterial infection.
The flu (influenza) virus and the virus that causes roseola,
which often are accompanied by high fevers, appear to be
most frequently associated with febrile seizures.
• Post-vaccination seizures
The risk of febrile seizures may increase after some childhood
vaccinations. These include the diphtheria, tetanus and
pertussis vaccine and the measles-mumps-rubella vaccine.
A child can develop a low-grade fever after a vaccination.
The fever, not the vaccine, causes the seizure.

14. • Risk factors
Factors that increase the risk of having a febrile
seizure include:
• Young age. Most febrile seizures occur in children
between 6 months and 5 years of age, with the
greatest risk between 12 and 18 months of age.
• Family history. Some children inherit a family's
tendency to have seizures with a fever.
Additionally, researchers have linked several
genes to a susceptibility to febrile seizures.

15. Treatment
• Simple : clobazam 5mg
• Complex: clobazam + antiepileptic drugs:
phenytoin 20mg/kg/day(LD)
valproate 20mgkg/day (MD)

16. Prevention
Giving your child medications
• Giving your child infants' or children's acetaminophen
or ibuprofen at the beginning of a fever may make
your child more comfortable, but it won't prevent a
seizure.
• Use caution when giving aspirin to children or
teenagers. Though aspirin is approved for use in
children older than age 3, children and teenagers
recovering from chickenpox or flu-like symptoms
should never take aspirin. This is because aspirin has
been linked to Reye's syndrome, a rare but potentially
life-threatening condition, in such children.

17. Prescription prevention medications
• Rarely, prescription anticonvulsant medications are
used to try to prevent febrile seizures. However, these
medications can have serious side effects that may
outweigh any possible benefit.
• Rectal diazepam or nasal midazolam might be
prescribed to be used as needed for children who are
prone to long febrile seizures. These medications are
typically used to treat seizures that last longer than five
minutes or if the child has more than one seizure
within 24 hours. They are not typically used to prevent
febrile seizure.

18. • If a child has febrile seizures :
-stay calm
-protect your child from injury
-do not attempt to restrain or held the child
down during the seizures
-turn the child onto his/her side if vomiting
occurs
-do not put anything in yours child mouth