Contributor: Alec Coston MD

Educational Pearls:

• Causes of seizures in a fairly well-appearing child with diarrhea:

• Electrolyte abnormalities: hypocalcemia, hyponatremia

• Also hyperkalemia which causes arrhythmias and syncope - can appear like seizures

• Hypoglycemia

• If the child has diarrhea and appears very sick, differential diagnosis may include:

• Hemolytic uremic syndrome (HUS):

• simultaneous occurrence of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury

• Typically caused by Shiga-like toxin producing Escherichia coli (also known as EHEC, or enterohemorragic E. coli)

• One of the main causes of acute kidney injury in children

• Toxic ingestions such as salicylates, lead, or iron

• In this case, the child had a seizure but appeared well and was afebrile:

• Consult with neurology led to a diagnosis of benign convulsions with mild gastroenteritis (CwG)

• First identified in 1982 in Japan

• Viral gastroenteritis with diarrhea and convulsions but does not include fever, severe dehydration, or electrolyte abnormalities

• Uncommon illness caused by rotavirus and norovirus pathogens

• Criteria for discharge is similar to a febrile seizure - the patient had one seizure that lasted less than 15 minutes and he quickly returned to his baseline, so he was able to be safely discharged home

• This diagnosis does not predispose him to epilepsy later in life

References

1. Lee YS, Lee GH, Kwon YS. Update on benign convulsions with mild gastroenteritis. Clin Exp Pediatr. 2022 Oct;65(10):469-475. doi: 10.3345/cep.2021.00997. Epub 2021 Dec 27. PMID: 34961297; PMCID: PMC9561189.

2. Mauritz M, Hirsch LJ, Camfield P, et al. Acute symptomatic seizures: an educational, evidence-based review. Epileptic Disorders. 2200;1(1). doi:https://doi.org/10.1684/epd.2021.1376

3. ‌Noris, Marina*; Remuzzi, Giuseppe*, †. Hemolytic Uremic Syndrome. Journal of the American Society of Nephrology 16(4):p 1035-1050, April 2005. | DOI: 10.1681/ASN.2004100861

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3

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