Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got the previous case on Diphtheria, Pertussis, and Tetanus: An Update of Evidence-Based Management of Pediatric Patients in the Emergency Department correct.
Case Presentation: Management of Pediatric Febrile Seizures in the Emergency Department
A 12-month-old girl presents to the emergency department after 2 seizures in the last 12 hours…
- The girl’s mother explains both events were approximately 3 minutes in length and consisted of generalized full-body shaking that resolved spontaneously. She tells you the girl is fully vaccinated, with a history of a prior febrile seizure. The girl’s measured maximum temperature at home was 101.3°F
- The girl’s vital signs are: temperature, 39.1°C; heart rate, 140 beats/min; blood pressure, 80/50 mm Hg; respiratory rate, 30 breaths/min; and oxygen saturation, 100%. On examination, the child is well-appearing and at baseline neurologically. Her mucous membranes are moist, and she has normal capillary refill. She has had a history of loose watery stools and 3 days of intermittent fevers, responsive to acetaminophen and ibuprofen. She has normal urinary output.
- What type of workup is indicated in the ED? What guidance should you provide to the family?
Case Conclusion
The girl was back to baseline after arrival to the ED and was tolerating oral rehydration. Due to risk for
urinary tract infection in this age group, urinalysis was completed, and it returned with 30 white blood
cells per high-power field and a positive leukocyte esterase. Since the girl remained well-appearing, she
was discharged home on an antibiotic course for urinary tract infection treatment. Appropriate doses of
ibuprofen and acetaminophen per weight were reviewed, and her family was counseled about the risk for
additional febrile seizures and what to do if a seizure occurred.
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Last Updated on October 14, 2025
