Keeled Over Kid

Author: Jessie Lynch / Editor: Steve Corry-Bass / Reviewer: Jessie Lynch / Codes: NeuC12, NeuP2, RP8, SLO5 / Published: 26/09/2023

A previously healthy 6-year-old female presents following a sudden unwitnessed collapse at school associated with urinary incontinence. This is followed by vomiting, a complaint of severe headache, a fluctuating level of consciousness and intermittent bradycardia. No seizure activity was witnessed. 

On examination she is afebrile and haemodynamically stable. Neurological examination demonstrates a fluctuating GCS of 10/15 (E2V3M5) to 13/15 (E4V4M5), spontaneous movement of all 4 limbs, down going plantars, and equal pupils with a sluggish reaction to light. 

Venous blood gas:

• pH 7.310 (7.35-7.45)
• pCO2 5.47kPa (4.7-6.0kPa)
• Base excess -5.3mmol/l (-2 to +2 mmol/l)
• HCO3- 20.6mmol/l (22-26mmol/l)Lactate 3.7mmol/l (0.5-2.2mmol/l)