Child With Stomach Aches, Drops To Ground, Heavy And Tingling Leg. Hyperventilating. Had Ekg And Eeg. Suggest?

Posted on Fri, 17 May 2013

Question: my 8 year old son, who is health otherwise has had 5 episodes in the last 2 years where he turns pale, bad stomach aches, almost passes out( drops to the ground), his last episode 1 week ago he was hyperventilating, and he said his right leg felt tingly and heavy- he has had 2 ekg's that are normal, also an eeg-normal

Answered by Dr. Tejas Shah (36 minutes later)

Many thanks for posting your query here at XXXXXXX

I can appreciate your anxiety in relation to this episodes and investigations so far have turned out to be normal.

I would like to know following to be able to guide you better:
1. Whether these episodes have always preceded by hyperventilation i.e. breathing fast/harder prior to the episode?
2. Do these episodes happen in a particular situation? (i.e. after some stressful or painful incidence)
3. Have any of these episodes happened when he is alone or in school?
4. Have you noticed any changes in his behaviour or school performance?
5. Do these episodes happen after strenuous exercise?
6. What happens after these episodes?k

Normal EKG doesn't rule out normal heart rhythm in this sort of scenario. What he needs is prolonged EEG recording for a period of 7 days or longer with the hope to capture any of these episodes and check whether heart rhythm was normal or not.

Sometimes, patients having hyperventilation can develop these symptoms. When they hyperventilate, Carbon dioxide levels in their body go down, develop low levels of acids in their blood (alkalosis) and leading to tingling, numbness. Oxygen supply to brain does decrease for few seconds or so and that can lead to dizziness.

I am waiting for your reply to above questions and we can discuss it further.

Regards
Dr Tejas Shah
Pediatrician

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Tejas Shah (32 minutes later)

only his last episode was followed by hyperventilating-it did not happen before. This has happened once at school, the rest other places with us, on vacation, at a DR. apt ( which was for me not him) at a playground, at a mall, at home, in my car.no changes in behavior- just really tired lately.they do not happen after exercise- he plays baseball and basketball and is fine. he is usually very tired after these episodes-this last on he was disoriented still when I finally got to his school, he was still very pale, and could not walk on his own- he was tired for 2 days after this last episode- he is normally a very active child. his DR. thinks he is having vasalvagals, and thinks no further testing is necessary- we do not agree-as there has not been any stress- or scarred feelings sourounding these episodes

Answered by Dr. Tejas Shah (19 minutes later)

Thanks for reverting back to me.

From the information you provided, it seems these episodes are unprovoked, can happen at any time and no precipitating factors have been found.

Vasovagal syncope can lead to similar symptoms. However, further investigations are needed before labelling it as syncope.

I would suggest a Consultation from Pediatric Neurologist should be helpful in this situation. There are certain tests like tilt-table test which can try to induce similar symptoms in laboratory settings to confirm the diagnosis. However, they are not 100% confirmatory of the diagnosis and are difficult to do in Pediatric patients.

Very rarely, it can be epileptic fit, presenting with colour change, stomach aches and then passing out (They are either termed as complex partial seizures or temporal lobe seizures).

I am aware that his previous EEG has been normal. He may need another EEG, with hyperventilation or sleep deprivation etc and see if it is different or showing anything abnormal.

I hope I have been able to guide you to take it forwards.
I would be interested to know outcome of his Neurology Consultation.

Regards
Dr Tejas Shah

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar