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Original Question

Case Study #4: A 10-day-old boy born in Canada on 11/30 was admitted with new-onset focal seizures. In the previous six days, his parents had noted left-sided arm and leg twitching, right-sided head turning and lip smacking. These episodes lasted for approximately 30 seconds and their frequency had increased to seven times per hour before admission. There was no history of fever, trauma, sick contacts, or neonatal sepsis risk factors. The baby was breastfed and supplemented with formula. The pregnancy was unremarkable, and the baby was born at term by an uncomplicated caesarian section because of a previous caesarian section. His birth weight was 4.1 kg (75-95th percentile). The mother was originally from Ecuador. The boy’s family history was otherwise noncontributory. On admission, focal seizures, as described, were witnessed. The baby’s weight was 4.1 kg. He was afebrile with normal vital signs. He had no dysmorphic features, and his physical examination was otherwise unremarkable. The laboratory blood tests revealed the following: Basic Metabolic Profile (BMP) Result Pediatric Reference Range Calcium 7.4 mg/dl 8.5 – 10.6 mg/dl Chloride (Cl-) 83 mEq/L 96-106 mEq/L Glucose 44 mg/dL 40-90 mg/dL Potassium (K+) 4.2 mEq/L 3.5 – 5.0 mEq/L Sodium (Na++) 132 mEq/L 130 – 140 mEq/L Blood urea nitrogen (BUN) 11 mg/dL 10 – 20 mg/dL Creatinine 0.65 mg/dL 0.2 – 0.9 mg/dL Bicarbonate (CO2)- venous 35.6 mEq/L 30 – 40 mEq/L Which electrolyte imbalance does this patient have? What in the case study might have contributed to this boy’s electrolyte imbalance? What are two interventions that might be used for this patient?

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