Age: 5.0
Sex: M
Vaccine: COVID19
Symptoms: Anion gap, Arrhythmia, Asthenia, Blood calcium normal, Blood chloride normal
Clinical narrative: Chief Complaint  Neurologic problem (Complaint of)  Arrival Date/Time: 01/21/2022 13:05:00 History of Present Illness    5 yo M with hx of autism (non-verbal) presenting with unresponsive episode. Pt was in usual state of health last night when he received his 2nd COVID-19 vaccine. He awoke today with fatigue and malaise that seemed to improve so pt went to school where he was sent home for malaise and fever (temp unknown). After arriving home, father went to change his pull up and while laying down pt was unresponsive and drooling and did not appear to be breathing. His eyes were open and rolled backwards. He appeared limp. No rhythmic jerking but family did say he seemed shaky earlier today. He turned blue during the episode so family called EMS and when police showed up, cyanosis resolved and pt had rapid, shallow breathing. He was sleepy afterwards but slowly improving.  POC glucose 185 en route. PIV placed. No meds or interventions performed. Tachy en route 140-150's.  He was given tylenol earlier today.  PMHx: Autism (non-verbal)  Home meds: None.  NKDA FMHx: NO hx of seizure or febrile seizure. Social Hx: Lives with family.  Attends school. Review of Systems    General: +fever, +decerased appetite today Neuro: no headache  or focal weakness. Skin: no rashes, bruising. HEENT: no vision changes, nasal congestion, sore throat. Cardiac: no chest pain. Respiratory: no cough, difficulty breathing, shortness of breath. GI: no recent nausea, vomiting, diarrhea. GU: no dysuria, hematuria. MSK: no joint pain or swelling.   10 ROS reviewed and otherwise negative   Physical Exam  Vitals & Measurements      T  HR  RR  BP  Sp02   First Set  37.4 DegC (01/21/22 13:15:25) 140 bpm (01/21/22 13:25:13) 28 br/min (01/21/22 13:25:13) 121/63 mmHg (01/21/22 13:25:13) 100 % (01/21/22 13:25:13)    VS as above.  GEN: sleepy, non-verbal, intermittently follows commands. No acute distress. HEENT: PERRL, clear conjunctiva, oropharynx clear, moist mucous membranes. NECK: supple, full neck ROM. No LAD. CV: RRR, no murmurs. RESP: CTAB. ABD: soft, nontender, non-distended.  EXT: warm, well perfused. NEURO: Moves all extremities equally. He is unable to cooperate with strength exam but full strength in lower extremities noted when touching his feet.  Normal gait but slow. Normal balance. No tremors.   Medical Decision Making     5 yo M with autism (non-verbal) presenting with unresponsive episode with cyanosis in the setting of malaise and fever post-COVID vaccine last night. DDx: febrile seizure, epileptic seizure, syncope, arrhythmia, myocarditis (post-vaccine), acute COVID-19 infection.  Plan: chemistry, troponin, EKG, ibuprofen, COVID PCR, observe   Reexamination/Reevaluation   15:45 - Pt is still sleeping. Feels warm to touch. HR downtrending. Labs significant for mild hyponatremia (Na 134), neg trop, neg rapid COVID/FLU/RSV PCRs. EKG normal. Will continue to observe to re-assess after waking.  16:57 - Pt is awake, alert and at baseline. Eating a banana. Care instructions and return precautions given to family. Family will follow-up with his primary Neurologist. Given this was a simple febrile seizure, he does not require Neuro consultation in ED or urgent EEG/imaging.   Final Diagnosis   1. Febrile seizure    Additional information for Item 19: Problem List/Past Medical History   Ongoing  Autism  Global developmental delay  Low muscle tone  Relative macrocephaly  Historical  No qualifying data  Procedure/Surgical History  No Procedure History Family/Social History   Basic Social History Living Arrangement Parent(s)/Guardian. Legal Guardian: Parent. Lives With: Mother, Father, Sister. Language Spoken at Home.  Medications Prescribed This Visit   Prescription  No prescriptions for this encounter  Allergies   No known allergies  Most Recent Results Current Encounter  Lab Results - Current Encounter    Sodium: 134 mmol/L Low (01/21/22 14:32:00)  Potassium: 4.38 mmol/L (01/21/22 14:32:00)  Chloride: 102 mmol/L (01/21/22 14:32:00)  CO2: 20 mmol/L Low (01/21/22 14:32:00)  Anion Gap: 12 mmol/L (01/21/22 14:32:00)  Glucose Level: 99 mg/dL (01/21/22 14:32:00)  BUN: 11 mg/dL (01/21/22 14:32:00)  Creatinine: 0.35 mg/dL (01/21/22 14:32:00)  Calcium: 9.4 mg/dL (01/21/22 14:32:00)  Phosphorus: 4 mg/dL (01/21/22 14:32:00)  Magnesium: 2 mg/dL (01/21/22 14:32:00)  Troponin T: <0.01 (01/21/22 14:32:00)  SARS-CoV-2 POCT: BINEG (01/21/22 14:32:00)  Influenza A POCT: BINEG (01/21/22 14:32:00)  Influenza B POCT: BINEG (01/21/22 14:32:00)  RSV POCT: BINEG (01/21/22 14:32:00)   Diagnostic Results   EKG: sinus tachycardia, normal intervals, normal axis. rsR' in V1 which is likely normal variant. No pre-excitation, WPW, Brugada, or prolonged QTc.