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Absence of serum chemistry abnormalities in pediatric patients presenting with seizures
1Department of Pediatrics, Carolinas Medical Center, Charlotte.
Insights
Routine serum chemistry tests for children after a seizure are generally not useful. This study found no clinically significant abnormalities in electrolytes, glucose, or other common chemistry values in pediatric seizure patients.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Chemistry
- Neurology
Background:
- Seizures are common in children, leading to frequent emergency department visits.
- Current practice often includes routine serum chemistry testing for pediatric seizure patients.
- The clinical utility of these routine tests remains debated.
Purpose of the Study:
- To evaluate the diagnostic yield of routine serum chemistry panels in children presenting with seizures.
- To determine if specific electrolyte or metabolic abnormalities are common in pediatric seizure episodes.
- To inform guidelines on the necessity of routine laboratory investigations.
Main Methods:
- Retrospective review of 241 pediatric seizure episodes in the emergency department.
- Analysis of serum chemistry values including sodium, glucose, BUN, calcium, and magnesium.
- Categorization of seizures into febrile and nonfebrile, initial and recurrent.
Main Results:
- Serum chemistry values were obtained in 64% of analyzed pediatric seizure cases.
- No clinically significant abnormalities were detected in serum sodium, glucose, BUN, calcium, or magnesium levels.
- This lack of abnormal findings was consistent across febrile, nonfebrile, initial, and recurrent seizure types.
Conclusions:
- Routine serum chemistry testing in pediatric patients presenting with seizures is not indicated.
- Testing should be reserved for cases with specific clinical indicators suggesting an underlying metabolic disturbance.
- This finding supports de-implementation of unnecessary laboratory tests in pediatric emergency care.
Abstract:
To determine the utility of the routine practice of obtaining serum chemistry values on children presenting after a seizure, we reviewed the emergency department records of 241 episodes of seizures in pediatric patients. One hundred fifty-five nonfebrile (49 initial, 106 recurrent) and 86 febrile (53 initial, 33 recurrent) convulsive episodes were analyzed. At least one serum chemistry value was obtained in 149 (64%) patients. Clinically significant abnormalities were found in 0/149 serum sodium, 0/148 glucose and blood urea nitrogen, 0/86 calcium, and 0/61 magnesium studies. We concluded that routine determination of serum chemistry values in pediatric patients presenting with a seizure is unnecessary unless specific clinical data strongly suggest otherwise.