Utility of Obtaining a Serum Basic Metabolic Panel in the Setting of a First-Time Nonfebrile Seizure

Area of Science:

• Pediatric Neurology
• Clinical Chemistry

Background:

• New-onset nonfebrile seizures affect a significant number of U.S. children annually.
• Electrolyte disturbances are potential causes of seizures, but their prevalence in healthy children with first-time seizures is not well-established.

Purpose of the Study:

• To investigate the frequency of seizure-provoking electrolyte disturbances (hyponatremia, hypoglycemia, hypocalcemia) in children presenting with new-onset nonfebrile seizures.
• To determine if electrolyte abnormalities are common in otherwise healthy children after a first-time nonfebrile seizure.

Main Methods:

• Retrospective review of 358 children (29 days to 18 years) diagnosed with "other convulsions" (ICD-9 code 780.39) between January 1, 2009, and May 31, 2009.
• Exclusion of children with known epilepsy or febrile seizures.
• Analysis of electrolyte levels (sodium, glucose, calcium) in children with and without concerning histories or physical examinations.

Main Results:

• Electrolyte levels were assessed in 13 of 14 children (93%) with concerning histories and 62 of 119 children (52%) with reassuring histories.
• No child with an unremarkable history and physical examination exhibited electrolyte abnormalities below seizure-associated thresholds.
• Electrolyte disturbances were found to be uncommon in this cohort.

Conclusions:

• Electrolyte abnormalities are unlikely to be the cause of new-onset nonfebrile seizures in otherwise well-appearing children.
• Routine electrolyte testing may not be necessary for all children presenting with a first-time nonfebrile seizure and a normal examination.