Case 3: Sudden Altered Mental Status in an 11-month-old Boy

Tamara Gayle

doi:10.1542/pir.2018-0108

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Tamara Gayle, MD, MEd*

^*Division of Hospital Medicine, Children’s National Medical Center, Washington, DC

AUTHOR DISCLOSURE
Dr Gayle has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

An 11-month-old boy presents to an emergency department (ED) after multiple witnessed episodes that were concerning for seizures. His parents note that he was in his normal state of health last night but this morning started becoming increasingly fussy. He then developed a blank stare and went limp. This happened 1 more time where he was seen to have perioral cyanosis. There were no convulsions, noted abnormal movements, or incontinence. He was quiet for a few minutes after this occurred but started to cry afterward. He was then taken to the community ED. He again developed a blank stare and went limp, which was witnessed by the care team on arrival in the ED. The family denies any fever or diarrhea, although he has had 2 episodes of nonbilious, nonbloody emesis after his staring episode. There was no witnessed ingestion or concern for nonaccidental or accidental trauma. He had been taking fluids well, with good urine output. There are no sick contacts at home, he does not attend child …