Febrile convulsions

Question 1

Features

Answer 1

The commonest cause is an upper respiratory infection.

Rare <6 mths and >5 yrs

Commonest age range 9–20 mths.

Recurrent in up to 50% of children

Consider meningitis

Perform lumbar puncture after first convulsion if <2 yrs or cause of fever not obvious

Epilepsy develops in about 2–3% of such children

Question 2

Management of the complex seizure (prolonged: >15 min)

Answer 2

Undress the child to singlet and underpants to keep cool but avoid getting cold

Maintain the airway and prevent injury

Place patient chest down with head turned to one side

Give oxygen 8 L/min by Hudson mask

Give midazolam buccal 2–5 mg/dose (undiluted from vial) 0.1–0.15 mg/kg IV or 0.2 mg/kg IM or intranasal or

Diazepam by one of two routes:

• IV 0.2 mg/kg, undiluted or diluted (10 mg in 20 mL N saline) or
• rectally 0.5 mg/kg (dilute with saline or in pre-prepared syringe); can be given as a suppository or rectal gel

Repeat after 5 mins if necessary but watch for respiratory depression (needs ventilation)

Check blood glucose; give IV dextrose

If still fitting, admit to hospital, rapidly induce ‘coma’ with propofol or thiopentone, then intubation with ventilatory support

Administer paracetamol once convulsion ceases, orally if conscious, rectally (15 mg/kg) if drowsy