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Nursing QUESTION #9258
Question 1
A 4-year-old child is admitted with generalized tonic-clonic seizures lasting 8 minutes. Temperature is 39.2°C. This is the child's first febrile seizure. Which statement about management is MOST accurate?
  • Immediate IV phenobarbitone loading is required
  • Lumbar puncture is mandatory in all first febrile seizures
  • Rectal diazepam 0.5 mg/kg is the first-line agent for active prolonged febrile seizures; simple febrile seizures require antipyretics and reassurance✔️
  • Long-term antiepileptic therapy should be started immediately
Correct Answer Explanation

Febrile Seizures — most common seizure type in children (6 months – 5 years):

FeatureSimpleComplex
Duration<15 minutes≥15 minutes
TypeGeneralizedFocal or generalized
Recurrence in 24 hrNoYes

This child had an 8-minute seizure — technically simple (but approaching complex threshold).

Management:

  • Active seizure (>5 min): Rectal/IV diazepam \(0.5\,\text{mg/kg}\) rectal or \(0.3\,\text{mg/kg}\) IV (max 10 mg)
  • Antipyretics: Paracetamol \(15\,\text{mg/kg}\) — reduces fever (does NOT prevent recurrence)
  • Reassurance: Risk of epilepsy <2–3% after simple febrile seizure
  • Long-term AEDs: NOT recommended for simple febrile seizures

Lumbar puncture indications in febrile seizure:

  • Age <12 months (mandatory)
  • 12–18 months (strongly consider)
  • Signs of meningism (neck stiffness, positive Kernig/Brudzinski)
  • Post-ictal state >1 hour
  • Not mandatory in all first febrile seizures