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    University of Medicine (1) Yangon Community Medicine Programme Community Oriented Case Presentation (Paediatric)

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    Thuta128
    1) A 16-month-old boy presented with one day of fever and one febrile seizure. He had a history of similar episodes and an underlying diagnosis of G6PD deficiency. 2) On examination, he was alert with a fever but no other abnormalities. His seizure was generalized and tonic-clonic in nature, lasting 10 minutes, with no neurological deficits after. 3) He was given a provisional diagnosis of simple febrile seizure with underlying G6PD deficiency. Differential diagnoses included pyogenic meningitis, viral encephalitis, TB meningitis, and cerebral malaria.

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    University of Medicine (1) Yangon Community Medicine Programme Community Oriented Case Presentation (Paediatric)

    Uploaded by

    Thuta128
    27 views18 pages
    1) A 16-month-old boy presented with one day of fever and one febrile seizure. He had a history of similar episodes and an underlying diagnosis of G6PD deficiency. 2) On examination, he was alert with a fever but no other abnormalities. His seizure was generalized and tonic-clonic in nature, lasting 10 minutes, with no neurological deficits after. 3) He was given a provisional diagnosis of simple febrile seizure with underlying G6PD deficiency. Differential diagnoses included pyogenic meningitis, viral encephalitis, TB meningitis, and cerebral malaria.

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    COCP Pae

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    1) A 16-month-old boy presented with one day of fever and one febrile seizure. He had a history of similar episodes and an underlying diagnosis of G6PD deficiency. 2) On examination, he was alert with a fever but no other abnormalities. His seizure was generalized and tonic-clonic in nature, lasting 10 minutes, with no neurological deficits after. 3) He was given a provisional diagnosis of simple febrile seizure with underlying G6PD deficiency. Differential diagnoses included pyogenic meningitis, viral encephalitis, TB meningitis, and cerebral malaria.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    27 views18 pages

    University of Medicine (1) Yangon Community Medicine Programme Community Oriented Case Presentation (Paediatric)

    Uploaded by

    Thuta128
    1) A 16-month-old boy presented with one day of fever and one febrile seizure. He had a history of similar episodes and an underlying diagnosis of G6PD deficiency. 2) On examination, he was alert with a fever but no other abnormalities. His seizure was generalized and tonic-clonic in nature, lasting 10 minutes, with no neurological deficits after. 3) He was given a provisional diagnosis of simple febrile seizure with underlying G6PD deficiency. Differential diagnoses included pyogenic meningitis, viral encephalitis, TB meningitis, and cerebral malaria.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 18

    UNIVERSITY OF MEDICINE(1) YANGON

     COMMUNITY MEDICINE PROGRAMME

    COMMUNITY ORIENTED CASE PRESENTATION


    (PAEDIATRIC)
    Presented by House Officers of UM1 1sposting ,2nd group
    Community Field Training Center
    (20.1.2020 to 3.2.2020)

    1
    Contributors
     
    Dr. Thaw Thae Phyu (Presenter)
    Dr. Thin Thu Htike(Leader)
    Dr. Thin Su Su Thein
    Dr. Thet Htar Swe
    Dr. Thawdar Pyayt Htun
    Dr. Thae Su Htoo
    Dr. Thinzar Su Zin

    2
    History Taking
    Personal identification
     Name – Mg SA
      Age- 1 6/12 years
     Sex- Male
     Religion- Christian
     Ethnicity- Kayin
    Address- Pat-tann village, Hmawbi Township
    Date of admission – 21.1.2020 (1:40 pm)
    Body weight – 8kg
     
    Chief complaint
    Fever x one day
    Fits x one time
      3
    History of Present Illness
    fever x one day
    • high grade in nature ( 101’F )
    • continuous in nature
    • not associated with chills and rigor
    • relieved by antipyretics

    Fits x one time


    • occurred at 1st day of fever and at the high of temperature
    • lasted for about 10 minutes
    • generalized tonic clonic in nature
    • during fits, there was no tongue biting and loss of
    consciousness, urinary incontinence
    • there was no neurological deficits after fits
    4
     There was no history suggestive of cerebral malaria
    such as travelling history and history of malaria.
     There was no history suggestive of pyogenic
    meningitis such as meningitis features (headache,
    photophobia and neck stiffness), source of infections
    (ear discharge, sinusitis and dental caries), skin
    pustules and head injury.
     There was no history suggestive of TB meningitis such
    as meningitis features, TB contact and TB history.
     There was no signs of increased ICP such as headache
    and projectile vomiting.
     There was no personality change.

    5
    Past Medical History
    He had similar attack at 8 months and 1 year of age

    Past Hospitalization History


    He was hospitalized to Yangon Children Hospital with
    yellowish discoloration of skin at 11 Days of age and diagnosed
    with G6PD deficiency.
    During hospitalization, he was treated with phototherapy for 2
    days.
     
    Past Surgical History
    No relevant past surgical history
     
    Family History
    No similar illness in family
    6
     

    Social History

    The income of the family is quite adequate.

    Maternal education is passed Grade 4

    There is no history of lead contact
     

    Drug History

    He is taking folic acid regularly since 11 Days of age.

    Birth History

    He was born with NSVD by midwife and birth weight
    was 7lbs and said to have no complications
      7
    Immunization History
     Completed
     
    Developmental history
     Not eventful
     
    Nutritional History
     Exclusive breast feeding until 6months and weaning
    diet starts at 6months and diet is well-balanced.

    8
    Physical Examination
    On admission
    General condition – ill
    Temp – 101’F
    Pulse rate – 100/min
    Heart – I+II+0
    Lungs – VBS+ 0

     Onthe day 2 of hospitalization


    The child is alert and interesting to the surrounding
    He has no dysmorphic features.
    There is no abnormal movement and posture.
     
    9
     He is febrile.
     He has no anemia and no jaundice. 
     He has no ear discharge, no sign of sinusitis and there
    is no skin rash.
     
     There is no irregular breathing.
     Pulse rate-120/min BP-90/60mmHg
     There is no neck stiffness, Kernig’s sign and
    Brudzinski’s sign.

    10
     There is no deformity, muscle wasting and muscle
    fasciculation.
     Muscle Tone – normal in both upper and lower limbs
     Power- 5/5 in both upper and lower limbs
     Reflex – deep tendon reflexes are normal in both
    upper and lower limbs
     There is no ankle and knee clonus.
     Flexor plantar response is detected.

    11
    Current treatment
    21.1.2020 – IV Ampicillin 200 mg 8hrly
    PR Diazepam 4mg, prn
    Paracetamol suppository 125mg stat follow
    by
    PO Paracetamol syrup 5ml (125mg) 6hrly
    PO cetirizine ½ 12hrly
    PO folic acid ½ OD
     
    Provisional Diagnosis
    A 1 6/12 years old child presenting with simple
    febrile seizure with underlying G6PD deficiency.
    12
    Point for Diagnosis
    Duration- 10min
    Occurred at the high of fever and 1st day of fever
    Generalized tonic clonic in nature
    No neurological deficit after fits
    Presence of similar attack

    Differential Diagnosis
    Pyogenic meningitis
    Viral encephalitis
    TB meningitis
    Cerebral malaria
    Brain abscess 13
     
    Fish Bone Diagram showing
    contributory factors to febrile convulsion
     
    Any cause like Poor knowledge about
      infection controlling fever

      Healthy Fever Fits Hospitalized


    child

    Lack of proper caring negligence

    14
    IMPACT OF FEBRILE CONVULSION
    On Individual Level
    Although febrile convulsion can be frightening to parents,
    brief febrile seizures do not cause any long term health
    problem.
    During a seizure there is a small chance that the child may
    be injured by falling or chocking with food or saliva in the
    mouth.

    Family level
    A child with convulsion can cause burden to other family
    members not only physically and mentally but also socially.
    It is non communicable disease but can also occur similar
    attack in his siblings and himself ,so need to increase
    awareness for it. 15
    PROBLEM SOLVING
    1.Individual Level and Family Level
     


    Advise the parents about the benign nature of disease and reassure
    them.

    Counselling about the risk of recurrence and risk of epilepsy

    Heath education to the parents about the first aid measures to
    perform and do and don’t during seizure

    Since this child has also underlying G6PD, explain the parents
    about the nature of this disease and advise to prevent naphthalene
    ball, beans and sulfur containing drugs etc.
     
     
     
     
     
     
     
     

     
     
     
    16
    2.Community Level
     Health education to the community level, especially
    to the patients about controlling fever not to get
    higher to prevent seizure
     parents about the first aid measures to perform and do
    and don’t during seizure

    Reference
     Pediatrics Management Guideline By Myanmar
    Pediatric Society 3rd edition
     Pediatrics for Undergraduates 2nd edition
     Davidson’s Principles and practice of Medicine
    17
    THANK YOU

    18

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