Thanks for your query at DoctorSpring.com
I can understand your concerns. At the outset, I must thank you for providing me with a detailed and relevant history containing all the important medical details.
Analyzing the whole sequence of events, the seizures could be because of one of the following reasons:
2. Heat-related or dehydration-related (though unlikely considering the current weather in Albania)
Your description of events and the suspicion is accurate. The most likely cause of the seizure was low blood sugar levels. The brain depends on glucose, and too little can impair its ability to function. Severe or prolonged hypoglycemia could result in seizures and serious brain injury.The vast majority of episodes of hypoglycemia in children and adolescents occur when a child with diabetes takes too much insulin and/or eats too little or exercises strenuously or for a prolonged period of time.
For non-diabetic children, the list of causes is entirely different. Single episodes may be caused by stomach flu, or another illness that may cause them to not eat enough, fasting for a prolonged period of time, prolonged strenuous exercise and lack of food. Recurrent episodes are usually caused by accelerated starvation, also known as “ketotic hypoglycemia', medications your child may be taking, a congenital (present at birth) error in metabolism or unusual disorder such as hypopituitarism, Addison's disease or hyperinsulinism. Other causes of hypoglycemia in children are rare.
I have gone through all her reports (blood tests). They do not provide any clue towards her underlying etiology. Blood glucose has been documented as normal. But, it could be fallacious because she drank juice before reaching the hospital. I would suggest that you do the following:
1. Get a fasting blood glucose tested in the morning within an hour or two of her waking up.
2. Get serum sodium and potassium (sodium and potassium disturbances may cause seizures; and may also be abnormal in Addison's disease or any corticosteroid insufficiency)
3. Get her serum total calcium, ionized calcium and phosphate levels.
This should suffice as of now. If she has a recurrence of such an episode, check her sugar using a hand-held glucometer. If she is indeed hypoglycemic, she may require a visit to a pediatric endocrinologist. She would then need her plasma insulin, serum cortisol, and C-peptide levels tested.
Till then, please make sure that she eats frequent meals and snacks throughout the day and has something to eat before going to bed. If she eats little at dinner, a hearty snack before bedtime (such as a glass of milk and peanut butter on toast) will keep her blood sugar levels stable throughout the night and in the early morning.
Dr. Saptharishi L G
Dr. Saptharishi L G
DM (Pediatric Critical Care) Senior Resident
MBBS, MD (Pediatrics), PGDCRL
Division of Pediatric Critical Care