What to do immediately for infants with seizures
Causes range from sepsis to hypoglycemia
If panicked parents bring in a seizing infant, the underlying cause could be life-threatening, but it also could have resulted from something as simple as drinking too much water.
Seizure caused by water intoxication is treated by gradual replenishment of sodium via intravenous (IV) fluid replacement, says Jennifer Anders, MD, an ED physician at Johns Hopkins Children's Center in Baltimore.
Perform these interventions immediately, says Anders:
- Start an IV or intraosseous line.
- Send blood to lab for stat electrolytes.
- Weigh the infant, and estimate the degree of dehydration, if any.
- Calculate the sodium deficit and any fluid deficit using the infant's weight, the estimated amount of dehydration and the difference between a normal sodium level and the laboratory result of the infant's sodium level.
"The sodium must be replaced slowly over a period of 24 to 48 hours," notes Anders. "Too rapid replacement of sodium can cause demyelination of the brain."
If it is determined that the cause of the seizure is related to water intoxication, rapid treatment to correct the hyponatremia is needed, says Mary Frey, RN, P-SANE, CPN, an ED nurse at Cincinnati Children's Hospital Medical Center. Before administering IV saline to correct the low sodium level that resulted from excessive oral intake of free water, obtain a baseline serum sodium level to determine the severity of hyponatremia, she says. "It may be necessary to intervene with medications to stop seizure activity."
Once the patient is stabilized and the serum sodium level is normalizing, you'll need to educate the caregivers, says Frey. "Infants are at risk for hyponatremic seizures due to their immature renal function and vigorous appetite," she says. "There are however, contributing factors that increase an infant's chance of developing hyponatremic seizures."
For example, infants that are recovering from vomiting and diarrhea-related illnesses might be dehydrated. Signs of dehydration in infants include a sunken fontanelle, sunken eyes, tacky mucous membranes, decreased urine output, decreased tearing or no tearing with crying, and tachycardia, says Frey.
"Additional signs of worsening dehydration include delayed capillary refill, weakening peripheral pulses, poor skin turgor and irritability, or decreased level of consciousness," she says. "Hypotension is a late sign of severe dehydration."
Sources
For more information on caring for infants with seizures, contact:
- Jennifer Anders, MD, Pediatric Emergency Medicine, Johns Hopkins Children's Center, Baltimore, MD. Phone: (410) 955-6143. E-mail: [email protected].
- Mary Frey, RN, P-SANE, CPN, Emergency Department, Cincinnati Children's Hospital Medical Center. E-mail: [email protected].
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