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No Further Acute Work Up in the ED

Regarding our own experience at Children’s Mercy Hospital (Zuccarelli & Hall (2015), 133 patients presenting with a first-time nonfebrile seizure, electrolytes were obtained in 13 of 14 (93%) children with a history suggestive of an underlying abnormality but also in half of children with a reassuring history (62 of 119, 52%). Importantly, no child with an unremarkable history and exam was found to have electrolyte abnormalities falling below levels most likely to be associated with acute symptomatic seizures (Na <115 mEq/L, glucose <40 mg/dL, Ca <5 mg/dL). Using even more conservative reference ranges (Na <135 mEq/L, glucose <60 mg/dL and Ca <8.5 mg/dL), 56 of 62 children (90%) with an unremarkable history and exam had normal results, and abnormal results did not change clinical management for any of these children.

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.