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[Status epilepticus induced by prolonged immersion in hot herb bath: report of one case]
Insights
A pediatric case of heat stroke in a 6-year-old girl with cerebral palsy resulted in multiple organ failure and death after a hot herbal bath. This highlights the risks of hyperthermia in children, especially those with underlying conditions.
Area of Science:
- Pediatric critical care medicine
- Environmental health and toxicology
- Neurology and developmental pediatrics
Background:
- Heat stroke is a severe hyperthermia condition, particularly dangerous in infants and children due to immature thermoregulatory systems.
- Predisposing factors include high ambient temperatures, dehydration, young age, and pre-existing conditions like cerebral palsy affecting thermoregulation.
Observation:
- A 6-year-old girl with cerebral palsy presented with conscious disturbance and generalized convulsions following a hot herbal bath.
- Initial examination revealed a rectal temperature of 41°C, hot skin, tachypnea (46/min), and altered mental status (Glasgow Coma Scale 4).
- Laboratory findings indicated significant metabolic derangements, including acidosis, elevated lactate dehydrogenase (LDH), and creatine phosphokinase (CPK), suggestive of widespread cellular injury.
Findings:
- The patient developed multiple organ failure, characterized by severe metabolic acidosis, central nervous system dysfunction, and elevated liver enzymes.
- Despite intensive cooling and anticonvulsant therapy (phenobarbital and diazepam), the patient's condition rapidly deteriorated.
- Cardiopulmonary arrest occurred 8 hours after admission, leading to expiration despite resuscitation efforts.
Implications:
- This case underscores the critical risk of heat stroke in children with cerebral palsy, emphasizing the need for extreme caution with environmental temperature exposure.
- The study highlights the distinct pathophysiology and increased vulnerability of heat stroke in pediatric populations compared to adults.
- It stresses the importance of prompt recognition and aggressive management of hyperthermia in children to prevent severe morbidity and mortality.
Abstract:
A 6-year-old girl with cerebral palsy developed conscious disturbance and generalized convulsion after one-hour hot herb drug bath. Physical examination on admission revealed rectal temperature 41 degrees C, hot skin, respiration 46/min, regular heart beat 98/min, BP 130/60 mmHg, Glascow coma scale 4 (E2M1V1), soft and flat abdomen, no hepatosplenomegaly, no skin rash, no focal neurological sign, increased generalized muscle ton. Laboratory data showed CBC: WBC 20400 cumm (Neutrophils 31%, Lymphocytes 69%), Hb 11.6gm%, ESR 11 mm/hr, arterial blood gas: PH 7.077, PO2 43mmHg, PCO2 57.1mmHg, HCO3- 16 mEq/L, BE-11.5mEq/L, serum sodium 143 mEq./L, potassium 5.2 mEq/L, chloride 101 mEq/L, free calcium ion 3.8mg%, GOT 63IU/L, GPT 263 IU/L, amylase 193 IU/L, alkaline phosphatase 388 IU/L, LDH 1245 IU/L, CPK 677 IU/L, total bilirubin 0.8 mg/dl, direct type 0.1 mg/dl, BUN 18 mg/dl, Glucose 35 mg/dl. Urinalysis revealed proteinuria( ) trace hematuria and pyuria, but no cast. Lumbar puncture is within normal limits. Bacteriology including blood and CSF are normal. Multiple organ failure was noted at that time. Intensive cooling methods were performed including central and peripheral cooling. We used luminal and valium to control the seizure. Condition didn't improve. Afterwards cardiopulmonary arrest developed. Patient expired 8 hours after admission despite of resuscitation. Heat stroke in infancy and childhood is different from that in adulthood. The predisposing factors are high ambient temperature, dehydration, very young baby, sweat gland dysfunction, or ectodermal dysplasia. Definition of heat stroke includes 1) rectal temperature above 41 degrees C, 2) behavioral change, 3) warm skin, wet or dry.(ABSTRACT TRUNCATED AT 250 WORDS)