Case Report

SIMPLE FEBRILE SEIZURE

Presenters : Chairul Ihsan Lubis (130100020)

: Grace Thangamani (130100348)
Day / Date : 2nd November 2017
Supervisor : dr. Yazid Dimyati, M.Ked(Ped), Sp.A (K)

1
 INTRODUCTION
Occurs in an increase in body temperature
(rectal temperature above 38 C) caused
by an extracranium process.
Divided by 2 : simple febrile seizure and
complex febrile seizure.

2
 INTRODUCTION
Febrile seizures are frightening, but they
are usually harmless.
Nevertheless, adequate treatment is
essential.
The prognosis of febrile seizures is
generally good.

3
 PURPOSE
To understand the theoretical science of
simple febrile seizures and to integrate the
acquired medical science of febrile
seizures as well as perform prompt and
accurate management in order to obtain a
good prognosis.

4
 PATIENTS CASE
HISTORY TAKING
Female patient, NH, age 1 year 11 months, admitted to
the emergency room of Universitas Sumatera Utara
Hospital on October 10, 2017 with major complaint of
seizure.
It has been experienced once, one day ago, the duration
was <5 minutes and the patient experience a stiff legs
and hands during seizures. Patient had fever before
seizure. After the seizure the patient became conscious.
This is the first time patient had seizure. Patient didnt
had seizure in emergency room. No family history of
seizures.

5
 HISTORY TAKING
Patients mother complained that patient had
fever one day before entering to hospital. The
fever rises slowly, all over the body with cold
feet. Patients did not shiver.
Cough, runny nose, thirst when drinking is
not found.
Nausea complained but not vomiting.
Urine is within the normal range

6
 HISTORY TAKING

Patient had diarrhea 2 times/day, one day

before entering the hospital, water >
dregs, blood not found, mucus
encountered. Feaces was colored blackish
brown with a volume of cup aqua every
diarrhea.

7
 HISTORY TAKING

Maternal pregnancy history: patient is the

first child. Mothers maternal age during
pregnant is 25 years old.
Ante natal care control to the midwife.
History of pain during pregnancy (-), fever
(-), hypertension (-), diabetes mellitus (-),
drugs (-).

8
 HISTORY TAKING

Birth history: Patient was born surgically by

OG spesialist. Born enough month, birth
weight was 2500 gram, birth length was 50c
m. History of blue appearance was not found,
patient cry loudly after born.
Immunization history : Complete.
Previous medical condition history : -
Drug Usage History :-

9
 HISTORY TAKING

History of diet intake :

0-6 months: Exclusive breastfeeding
6-8 months: Breastfeeding + milk porridge
8-12 months: Breastfeeding + Rice
porridge
> 1 year: Breastfeeding + Family Rice

10
 HISTORY TAKING

History of growth
5 Months Face down
8 Months - Crawling
10 Months - Sit down
1 year 5 months - walking
1 year 7 months - can talk 1-3 words

11
 PHYSICAL EXAMINATION :
Present status:
Awareness: GCS 15 (E4V5M6), Alert,
Blood Pressure : 90/50 (N= 84 - 97 / 39 - 54) HR : 130
x/min (N= 80-140) RR : 22 x/min Temp : 37.7 C,
Weight: 10 kg, Height: 73 cm
Weight / Age: -2 < z score < 0
Height / Age: z score < -3
Weight / Height: 1 < z score < 2
General situation: moderate, disease state: moderate
and nutritional state: good.
There was no dyspnoea, anemic, jaundice, cyanosis,
and edem

12
13
14
15
 PHYSICAL EXAMINATION :
Localized status:
Head : the anterior frontanelle is closed
Eyes : Light reflex (+ / +), equal pupil,
conjunctival palp inf pale (- / -)
Ears : No abnormalities
Nose : No abnormalities
Mouth: No abnormalities
Neck : Lymph nodes enlargement (-). Neck
rigidity (-)

16
 PHYSICAL EXAMINATION :
Torax: symmetrical fusiformis, retraction (-)
Heart rate: 130 times / min, regular,
murmur (-)
Respiratory rate: 20 times / min, regular,
ronki (- / -)
Abdomen: Soepel, peristaltic sound (+)
normal. Liver / spleen: not palpable.
Turgor return fast.

17
 PHYSICAL EXAMINATION :

Extremities: pulse 130 x / min, reg, warm

extremities, pressure / volume enough,
CRT <3 ". Cyanosis (-) edema (-).
Physiological reflex = APR / KPR (+ / +).
Pathological reflex = babinski (-) chaddock
(-)

18
 PHYSICAL EXAMINATION :
Diagnosis: Simple febrile seizure
Therapy :
- Bed rest
- Family food diet 900 kcal + 22 gr protein
- IVFD D5% NaCl 0.45% 45cc / hr (Micro)
- Inj.Paracetamol 100mg / 4 hours / IV
Planning : - Complete blood count
- Urinalysis

19
 Laboratory results (Date: 10/10/2017)

Blood Complete Result Referral____

Hemoglobin : 10.4 g/dL (12.0 16.0)
Erythrocytes : 4.69 million/L (3.6 5.2)
Leukocytes : 8.650 /L (6.000 17.00)
Hematocrit : 32.30% (37 41)
Platelets : 362.000 /L (150.000 440.000)
Calculate Type
Neutrophils : 68.4 % (50.00 - 70.00)
Lymphocytes : 12.5 % (20.00 - 40.00)
Monocytes : 19.0 % (2.00 - 8.00)
Eosinophils : 0.0 % (1.00 - 6.00)
Basophils : 0.1 % (0.00 - 1.00)

20
 Laboratory results (Date: 11/10/2017)
Urinalysis Result Referral _____
Macroscopic
Colour : Yellow Yellow
Clarity : Clear Clear
Chemistry
pH : 6.0 (5 - 8)
Weight Type : 1.010 (1.005 1.030)
Protein : Negative Negative
Glucose : Negative Negative
Bilirubin : Negative Negative
Urobilinogen : Normal
Ketone : Negative Negative
Blood : Negative Negative
Nitrite : Negative Negative

21
 Laboratory results (Date: 11/10/2017)

Sediment (Microscopic)
Leukocytes :0-2 <6
Erythrocytes :0-1 <3
Epitel :0-1
Cylinder : Negative
Crystal : Negative Negative
Bacteria : Negative Negative

22
 Monitoring (October 10, 2017)
S: seizure (-), Fever (+)
O: Temp: 38 C
Head: Eyes: Light reflex (+ / +), equal pupils, conj pal inf pale (-) / (-)
Ear / Nose / Mouth : Within normal limits
Neck: Lymph node enlargement (-), neck rigidity (-)
Torax: Symmetrical fusiformis, retraction (-)
Heart rate: 130 x / min, regular, sigh (-)
Respiratory rate: 22 x / min, regular, ronki (- / -)
Abdomen: Soepel, normal peristaltic (+), Hepar / lien: not palpable, turgor
return fast
Extremities: Pulse: 130 times / min, regular, enough pressure / volume, CRT <3 "
Diagnosis of work: Simple febrile seizures
Therapy: IVFD D5% NaCl 0.225% 30cc / hr (Micro)
Diet family food 900 kcal with 22 gr protein
IInj. Paracetamol 90mg / 4 hours / IV
R / Check Urinalysis

23
 Monitoring (October 11, 2017)
S: seizures (-), Fever (+), Vomiting (+)
O: Temp: 38.1 C
Head: Eyes: Light reflex + / +, equal pupils, conj pal inf pale (-) / (-)
Ear / Nose / Mouth : Within normal limits
Neck: Lymph node enlargement (-), neck rigidity (-)
Torax: Symmetrical fusiformis, retraction (-)
Heart rate: 110 x / min, regular, sigh (-)
Respiratory rate: 22 x / min, regular, ronki (- / -)
Abdomen: Soepel, normal peristaltic (+), Hepar / lien: not palpable, turgor
return fast
Extremities: Pulse: 110 x / min, regular, enough pressure / volume, CRT <3 "
Diagnosis of work: Simple febrile seizure
Therapy: IVFD D5% NaCl 0.225% 30cc / hr (Micro)
Diet family food 900 kcal with 22 gr protein
Inj. Paracetamol 90mg / 4 hours / IV

24
 Monitoring (October 12, 2017)
S: seizures (-), Fever (+), Vomiting (-)
O: Temp: 37.9 C
Head: Eyes: Light reflex + / +, equal pupils, conj pal inf pale (-) / (-)
Ear / Nose / Ear: Within normal limits
Neck: Lymph node enlargement (-), neck rigidity (-)
Torax: Symmetrical fusiformis, retraction (-)
Heart rate: 80 x / min, regular, sigh (-)
Respiratory rate: 20 x / min, regular, ronki (- / -)
Abdomen: Soepel, normal peristaltic (+), Liver / spleen: not palpable, turgor
return fast
Extremities: Pulse: 80 x / min, regular, enough pressure / volume, CRT <3 "
Diagnosis of work: Simple febrile seizure
Therapy: IVFD D5% NaCl 0.225% 30cc / hr (Micro)
Diet family food 900 kcal with 22 gr protein
Inj. Paracetamol 90mg / 4 hours / IV

25
 Monitoring (October 13, 2017)
S: seizures (-), Fever (+), Vomiting (-)
O: Temp: 37.8 C
Head: Eyes: Light reflex + / +, equal pupils, conj pal inf pale (-) / (-)
Ear / Nose / Mouth: Within normal limits
Neck: Lymph nodes enlargement (-), neck rigidity (-)
Torax: Symmetrical fusiformis, retraction (-)
Heart rate: 90 x / min, regular, sigh (-)
Respiratory rate: 22 x / min, regular, ronki (- / -)
Abdomen: Soepel, normal peristaltic (+), Liver / spleen: not palpable, turgor
return fast
Extremities: Pulse: 90 x / min, regular, enough pressure / volume, CRT <3 "
Diagnosis of work: Simple febrile seizure
Therapy: IVFD D5% NaCl 0.225% 30cc / hr (Micro)
Diet family food 900 kcal with 22 gr protein
Inj. Paracetamol 90mg / 4 hours / IV
Inj. Phenytoin 80mg / 12hr then 40mg / 12hr in Nacl 0.9% 20cc

26
 Monitoring (October 14, 2017)
S: seizures (-), Fever (-),Vomiting (-)
O: Temp: 37.4 C
Head: Eyes: Light reflex + / +, equal pupils, conj pal inf pale (-) / (-)
Ear / Nose / Mouth: Within normal limits
Neck: Lymph node enlargement (-), neck rigidity (-)
Torax: Symmetrical fusiformis, retraction (-)
Heart rate: 88 x / min, regular, sigh (-)
Respiratory rate: 20 x / min, regular, ronki (- / -)
Abdomen: Soepel, normal peristaltic (+), Liver / spleen: not palpable, turgor
return fast
Extremities: Pulse: 88 x / min, regular, sufficient pressure / volume, CRT <3 "
Diagnosis of work: Simple febrile seizure
Therapy: IVFD D5% NaCl 0.225% 30cc / hr (Micro)
Diet family food 900 kcal with 22 gr protein
Inj. Paracetamol 90mg / 4 hours / IV
Inj. Phenytoin 40mg / 12h in Nacl 0.9% 20cc

27
 Monitoring (October 15, 2017)
S: seizures (-), Fever (-)
O: Temp: 36.9 C
Head: Eyes: Light reflex + / +, equal pupils, conj pal inf pale (-) / (-)
Ear / Nose / Mouth: Within normal limits
Neck: Lymph node enlargement (-), neck rigidity (-)
Torax: Symmetrical fusiformis, retraction (-)
Haert rate: 88 x / min, regular, sigh (-)
Respiratory rate: 22 x / min, regular, ronki (- / -)
Abdomen: Soepel, normal peristaltic (+), Liver / spleen: not palpable, turgor
return fast
Extremities: Pulse: 88 x / min, regular, sufficient pressure / volume, CRT <3 "
Diagnosis of work: Simple febrile seizure
Therapy: IVFD D5% NaCl 0.225% 30cc / hr (Micro)
Diet family food 900 kcal with 22 gr protein
Inj. Paracetamol 90mg / 4 hours / IV
Inj. Phenytoin 40mg / 12h in Nacl 0.9% 20cc

28
 Monitoring (October 16, 2017)
S: seizures (-), Fever (-),
O: Temp: 36.7 C
Head: Eyes: Light reflex + / +, equal pupils, conj pal inf pale (-) / (-)
Ear / Nose / Mouth: Within normal limits
Neck: Lymph nodes Enlargement (-), stiff neck (-)
Torax: Symmetrical fusiformis, retraction (-)
Heart rate: 92 x / min, regular, sigh (-)
Respiratory rate: 20 x / min, regular, ronki (- / -)
Abdomen: Soepel, normal peristaltic (+), Liver / spleen: not palpable, turgor
return fast
Extremities: pulse: 92 x / min, regular, enough pressure / volume, CRT <3 "
Diagnosis of work: Simple febrile seizure
Therapy: IVFD D5% NaCl 0.225% 30cc / hr (Micro)
Diet family food 900 kcal with 22 gr protein
Inj. Paracetamol 90mg / 4 hours / IV
Inj. Phenytoin 40mg / 12h in Nacl 0.9% 20cc

29
R / patient was discharged on 16 October
2017 and given the medicine of
Paracetamol syr 3x1 cth

30
 DISCUSSION
Theory Patients Case
Febrile seizures are a seizure spasm
that occurs in an increase in body
temperature (rectal temperature above
38 C) caused by an extracranium
process.
2 - 4 % between 6 months - 5 years Age : 1 year and 11 months old.
Simple febrile seizures = 80% Simple febrile seizure.
Boys : girls with a ratio of 1.4 : 1 Female patient.

Etiology : infection, vaccine and

genetic.

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 Theory
Clinical Manifestation
Elevated core temperature (39C or
more)
Seizure occurs within the first 24
hours after fever.
Febrile seizures occur briefly (less
than 15 minutes)
Tonic, clonic movement or focal
seizures
During seizures patient
unconscious, after seizures patient
conscious.
Diagnostic Examination
History Taking
Physical Examination
Laboratories Examination
Others
Patients Case
Patients had fever before the
seizure.
Duration <5 minutes.
Legs and hands are stiff.
The patient is conscious after the
seizure.
First seizure experienced by the
patient.
Family history of seizures (-)
History
Seizure (+)
Fever (+)
Diarrhea (+)
Physical Examination
Awareness, general state, vital sign
within normal limits.
No signs of infection.
Laboratories Examination
Complete Blood Count 32
Urinalysis
 Theory Patients Case
Medication Medication
Diazepam IVFD D5% NaCl 0.225% 30cc / hr
Phenytoin (Micro)
Antipyretics Diet family food 900 kcal with 22 gr
Phenobarbital or Valproic acid protein
Inj. Paracetamol 90mg / 4 hours / IV
Inj. Phenytoin 80mg / 12h then
40mg / 12hr in Nacl 0.9% 20cc

Prognosis
Generally good
Neurological defects or deaths were
never reported.
The possibility of recurrence of
febrile seizures is 0-15%
The likelihood of future epilepsy is
5%

33
 CONCLUSION
The 1-year-old and 11 months female patient, NH, came with a major complaint
of seizure, the patient was diagnosed with a simple febrile seizure and was
treated with :
IVFD D5% NaCl 0.225% 30cc / h (Micro)
Diet family food 900 kcal with 22 gr protein
Inj. Paracetamol 90mg / 4 hours / IV
Inj. Phenytoin 80mg / 12h then 40mg / 12h in Nacl 0.9% 20cc

Patients was sent home on October 16, 2017 and were given medicine
Paracetamol syr 3 x 1 cth.

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