The child has vomiting, diarrhea and convulsions. What is the reason?

time:2022-10-07 author:Cry
The child has vomiting, diarrhea and convulsions. What is the reason?

*For reference only for medical professionals

A child with vomiting, diarrhea and convulsions comes to the pediatric emergency room. What diseases would you consider?

Usually the child's vomiting and diarrhea are enough for parents to worry about, and it is accompanied by convulsions, which can frighten parents enough. How should a doctor diagnose and treat such a situation? Follow the cases shared by the author below to learn about the diseases related to the above symptoms. The case-sharing child, male, 2 years old, came to the clinic because of "vomiting, diarrhea for 1 day, and convulsion for 1 minute". History of present illness: The child had vomiting yesterday without obvious incentive, non-projective, vomit was stomach contents, no coffee-like substance, about 2~3 times/day; ~8 times/day. Today, the patient had a sudden seizure, manifested as binocular staring, trismus, generalized tonic-clonic seizures, and loss of consciousness, which lasted for about 1 minute and resolved. After remission, the child's consciousness became clear and the spirit was good. Since the onset of the disease, the child has no fever, no cough, no runny nose, good spirits, normal appetite, stool as described above, and normal urine output. Physical examination: the spirit is OK, and there is no dehydration appearance. There were no rashes and subcutaneous hemorrhages on the whole body. The abdomen was soft, there was no crying when pressed, and bowel sounds were 6 times/min. Cardiopulmonary examination showed no abnormality. The neck was soft, without resistance, and the meningeal irritation sign was negative. The muscle strength and muscle tone of the limbs were normal, and the pathological reflexes were not elicited. ▌ Laboratory examination: Routine blood: liver and kidney function, electroencephalogram, and brain MRI showed no abnormality. Fecal rotavirus antigen (+). Clinical thinking 1. The child has afebrile convulsions, but the mental state after the convulsions is normal, unconscious, and no abnormality in the nervous system examination. Although the lumbar puncture and cerebrospinal fluid examination are not perfected, the possibility of central nervous system infection is considered smaller. 2. Combined with the symptoms of acute gastroenteritis such as vomiting and diarrhea, without electrolyte and acid-base balance disorders, positive fecal rotavirus antigen, and no abnormality in EEG and brain MRI, consider mild gastrointestinal Benign infantile convulsions with mild gastroenteritis (BICE) is a disease that is easily overlooked in clinical practice and needs attention. 3. Since the child did not have convulsions after admission, only oral probiotics were given to regulate intestinal flora disturbance, oral montmorillonite powder to protect gastrointestinal mucosa, fluid replacement and symptomatic and supportive treatment. After treatment, the patient's condition improved and he was finally discharged from the hospital. Regular follow-up after discharge showed normal mental and motor development. BICEBICE is a type of disease mainly manifested as transient generalized convulsions, accompanied by mild gastroenteritis symptoms, without obvious dehydration and electrolyte imbalance, and mostly occurs in previously healthy infants and young children. 1 The etiology is not yet clear, it may be related to viral (especially rotavirus) or bacterial infection. In addition, the central nervous system damage caused by infection-mediated immune mechanism is also closely related to the pathogenesis. 2 Clinical manifestations 1. Symptoms of mild gastroenteritis: diarrhea, vomiting, may be accompanied by mild dehydration, without obvious electrolyte and acid-base balance disorders. 2. Convulsions: There may be one or more seizures in the course of the disease, which can be induced by pain or crying, mainly manifested as generalized tonic-clonic seizures or partial seizures generalized to generalized seizures, with short duration and short duration of seizures. Mostly afebrile convulsions, but also may be accompanied by low fever (body temperature <38 ℃). 3. Normal mental and motor development before and after onset. 3 Auxiliary examinations 1. Blood and stool routines vary due to the pathogen of infection, and urine routines are normal. 2. Blood biochemistry and blood gas analysis were normal. 3. Routine and biochemical examination of cerebrospinal fluid were normal. 4. Rotavirus can be detected in most children. 5. The EEG background activity during the interictal period was normal, and there was no abnormal discharge. 6. Brain imaging examination: most cases showed no abnormality in craniocerebral CT and MRI examinations. 4 diagnostic criteria 1, often occurs in winter and spring. 2. Often occurs in previously healthy infants and young children aged 6 months to 3 years old. 3. Afebrile convulsions occur on the 1st to 5th day of the course of viral gastroenteritis, mostly short-term generalized tonic-clonic seizures. 4. There may be mild dehydration. 5. Convulsions tend to recur over several days. 6. Fecal rotavirus antigens can often be detected. 7. Other laboratory tests were normal, including cerebrospinal fluid, serum electrolytes, and blood sugar. 8. The prognosis is good. 5 Differential diagnosis 1. Febrile convulsions: the seizure form is similar to BICE, mainly manifested as generalized tonic-clonic seizures, normal EEG between seizures, good prognosis, more than one seizure in each course of the disease, and the body temperature during the seizure is mostly above 38.5°C. On the other hand, children with BICE will have clustered seizures, mostly afebrile seizures. 2. Rotavirus encephalitis: Fever, disturbance of consciousness, convulsions and other manifestations may occur. The cerebrospinal fluid examination is consistent with the characteristics of viral encephalitis, and the background of EEG between attacks is continuous slow activity. On the other hand, BICE had no symptoms of lethargy, lethargy, restlessness, irritability, limb weakness, ataxia, and had normal EEG background activity between episodes. 3. Breath-holding seizures: Some BICE children's seizures are induced by pain or crying, so they need to be differentiated from breath-holding seizures. Cry-induced BICE seizures were long in duration, more than 20 seconds, while breath-holding seizures were mostly less than 15 seconds. In addition, crying can no longer induce convulsions after BICE is cured, while breath-holding seizures often occur and have nothing to do with diarrhea. 6 Treatment This disease is a self-limiting disease and only needs to be treated in the acute phase, and no long-term treatment is required after the convulsions are controlled. 1. Control convulsions: Diazepam is the first choice, the dose is 0.1mg/kg~0.3mg/kg each time, slow intravenous injection, pay attention to observe whether there is respiratory depression, or choose phenobarbital, the dose is 10mg/kg~15mg/kg Each time, intramuscular injection. In addition, oral 10% chloral hydrate can also be selected. Also pay attention to keep the airway open during convulsions. 2. Symptomatic and supportive treatment: Symptomatic and supportive treatment such as protecting the gastrointestinal mucosa, regulating intestinal flora disturbance, preventing electrolyte and acid-base balance disturbance, and rehydration. 7 Prognosis Children with BICE have a good prognosis, have no significant impact on the mental and motor development of children, and have a low incidence of recurrent seizures and rarely develop epilepsy. In clinical practice, unnecessary long-term antiepileptic drug treatment should be avoided. Summary: When we encounter children without febrile convulsions clinically, they are accompanied by acute gastroenteritis symptoms such as vomiting and diarrhea, without electrolyte and acid-base balance disorders. Moreover, the mental and motor development was normal before and after the onset of the disease, and the EEG during the interictal period was normal. The disease BICE should be considered. And in the event of a seizure, stop the convulsion in time, keep the airway open, pay attention to symptomatic and supportive treatment, prevent dehydration and electrolyte imbalance, and avoid unnecessary examinations and excessive drug treatment. References: [1] Xue Chaochao, Liang Yafeng, Pan Guoquan, et al. Clinical analysis and follow-up study of mild gastroenteritis with benign convulsions in infants and young children [J]. Chinese Journal of Contemporary Pediatrics, 2017, 19(11): 1191-1195. [2] Wang Aiping. 26 cases of mild gastroenteritis with benign convulsions in infants and young children [J]. Clinical Journal of Practical Pediatrics, 2012, 27(16): 1291-1292. [3] Zheng Juying, Chen Xiaodong, Chen Yongming, et al. Clinical analysis of 20 cases of mild gastroenteritis with benign convulsions in infants[J].International Journal of Pediatrics,2014(4):446-447.[4]Zhang Yuanda, Ji Chaoyu, Li Rongmin, et al. Clinical analysis of 264 cases of benign convulsions [J]. Journal of Clinical Pediatrics, 2015(10): 857-859. This article was first published: Pediatrics Channel of the Medical Community Station App has 👇1. Scan the QR code below 2. 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