2009 Southern Regional Meeting Abstracts

Case Report: 10 week old FT baby girl was transferred from an OSH ED with a first-time seizure. The baby was in her usual health when mom dropped her off at the father’s home earlier that day. She picked her up 4 hours later and noticed she felt hot to touch and was sweating, then began to shake and her eyes rolled back in her head. She was taken to an OSH where she was noted to have bilateral upper extremity shaking and R eye deviation. She was given 2 doses of Lorazepam with no cessation of seizure activity, then a loading dose of Fosphenytoin which stopped the seizure. She was noted to be febrile to 102. Blood and urine cultures were sent, an IO was placed secondary to inability to place an IV, and doses of Vancomycin and Ampicillin given. PE on arrival in our ED: T 100.9 P 175 R 65 BP 101/60 Sat 98% RA. In general she was awake, well nourished infant, AFSF, no scalp hematoma or markings, TM clear, no nasal discharge, pink MMM with clear OP, pupils 8mm and equal and sluggishly reactive, no eye deviation, heart tachycardic with RR, no murmur, strong distal pulses, lungs CTAB no inc WOB, ab soft, NTND, IO in R proximal tibia, no extremity deformities/tenderness/abnormal movements, skin diaphoretic with no rash or markings, awake but did not fix/follow, respond to voice, or cry appropriately with painful stimuli. Noncontrast head CT showed no fracture or intracranial hemorrhage. Labs showed CBC:WBC 14.0 Hb 9.4 Hct 27.0 Plt 474 43S/52L/0B; Lytes: Na 146 K 5.1 Cl 116 HCO3 19 BUN 8 Cr 0.3 Glu71 Ca 9.9; LFT: TP 6.0 Alb 3.9 ALT 31 AST 67 AP 276 TB 0.3; UA: SG >1030 1+ ketones 1-3 WBC 2-3 RBC few bacteria; CSF: Prot 41 Glu 50 WBC 0 RBC 0 GS neg; Blood, urine, CSF cultures, HSV PCR pending; Urine tox screen: positive for benzodiazepines, amphetamine, methamphetamine. This infant presented with a classic sympathomimetic toxidrome, though it would have been easy to overlook based on her age. This case illustrates the importance of keeping ingestions in the differential in all age groups. The baby was admitted for observation and antimicrobials until cultures returned negative. Toxicology and social work were consulted. The baby's father's girlfriend admitted to giving the child crystal meth in an attempt to harm her. She was arrested. The baby remained seizure-free and was discharged home with mom.