Infant Presents with Status Epilepticus, Emesis, Diarrhea part 2


• Gave 2 pushes of normal saline and started the child on antibiotics.


• The patient died 3 days after admission.


James Lace, MD Childhood Health Associates of Salem; Mt. Meru Hospital, Tanzania; Kausay Wasi Clinic, Peru


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Status epilepticus
• Critically ill infant

Differential Diagnosis

• Seizure (status epilepticus)

• Accidental poisoning

• Hypoglycemia

• Hypovolemic shock Patient

Workup History

• Mom was not forthcoming that she given the child herbal remedies.

• Patient had had some vomiting and diarrhea.

• Family had seen a local healer, who gave the patient two different types of herbs.

• Patient had severe complications before we found out about herbs/poisoning.

Physical Exam

• Pinpoint / non-reactive pupils

• Cap refill >6 seconds

• Blood sugar 0 on glucometer

• Seizures; stopped with rectal diazepam

Editor’s Notes

I’m not sure if we could have saved this child; we didn’t know what herbs she had been given. But if you see pinpoint pupils in a developing country, think of opiods and of organophosphates that can cause poisoning. -Dr. James Lace It is not clear what the cause of this child’s death was, although poisoning with organophosphates is a reasonable working diagnosis. Such poisoning is sometimes reversible, although the reversal agents are not commonly available in resource-poor settings. Atropine can sometime give temporary improvement, but often needs to be given repeatedly over days while the patient recovers. If the patient survives an acute episode of organophosphate poisoning, they can still have long-term neurologic deficits

~ Dr. Keith Cross, Associate Professor of Pediatrics/Emergency Medicine, University of Louisville

Suggested References

Status epilepticus


• Gender: Female

• Age: 9 month

• Height: Not Available

• Weight: Not Available


• Temperature: 100.4 F/38 C

• Blood Pressure: Not Available

• Heart Rate: Not Available

• Respiratory Rate: Not Available

• Pulse Oximetry: 95% RA

Signs and Symptoms

Low blood sugar; seizures; non-reactive pupils; vomiting; diarrhea.

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