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Woke Up Unresponsive. MRI Showed Nothing. Suggested To Visit Geneticist With Blood Test Report. What Could Have Happened?
Question: HCM0000
My son is 7 years old and had been transported to our local ER after becoming unresponsive after waking up in the am. When we were at the hospital they ran stat blood work and an MRI . He woke up out of the blue over 1 hour later. They released us that same day after observation with the instructions to go see a geneticist. I'm very confused...why unresponsive and why a geneticist . The MRI showed nothing but the blood work is what they gave us to give to the doctor at Nemours hospital for children. Any clue what happened?
Lipase Level L 8, Alkaline Phosphatase H 203, UR ketone 4+, UR Protein 1+, UR mucus trace, WBC H 19.5, Seg% H 65, Bands% H15, Lymphs % L 13, Monos% H 1.4, Chloride L 97, Co2 L 16, Anion Gap H 26, BUN H 27, Creatinine L 0.3, Neutrophils absolute H 15.6, and last MonosH 1.4.
My son is 7 years old and had been transported to our local ER after becoming unresponsive after waking up in the am. When we were at the hospital they ran stat blood work and an MRI . He woke up out of the blue over 1 hour later. They released us that same day after observation with the instructions to go see a geneticist. I'm very confused...why unresponsive and why a geneticist . The MRI showed nothing but the blood work is what they gave us to give to the doctor at Nemours hospital for children. Any clue what happened?
Lipase Level L 8, Alkaline Phosphatase H 203, UR ketone 4+, UR Protein 1+, UR mucus trace, WBC H 19.5, Seg% H 65, Bands% H15, Lymphs % L 13, Monos% H 1.4, Chloride L 97, Co2 L 16, Anion Gap H 26, BUN H 27, Creatinine L 0.3, Neutrophils absolute H 15.6, and last MonosH 1.4.
Brief Answer:
Needs further evaluation
Detailed Answer:
Hi XXXXXXX
Thank you for your query on Healthcare Magic.
The unresponsive episode of the child in the morning looks like a seizure episode or a hypoglycemic episode.
Seizures usually presents with involuntary movements or unconsciousness depending on the type of seizure followed by a state of unconsciousness and unresponsiveness(postictal state).
Whereas hypoglycemic episode (low blood glucose) will present with an episode of unresponsive state with or without seizures.
In some disorders like glycogen storage disorders children present with low blood glucose especially in the early morning because of over night fasting.
And seizures, hypoglycemic episodes tend to occur during sleep in the nigh times.
My opinion of cause for his unresponsiveness is a seizure episode or an episode of low blood glucose.
Presence of 4+ ketones in urine is abnormal and it denotes ketosis in the body which is seen in starvation, diabetic ketoacidosis, and glycogen storage disorders.
The raised WBC count and high neutrophil count is suggestive of infection or stress related.
The idea behind referring the child to geneticist could be for the evaluation to look for inborn errors of metabolism such as glycogen storage disorder or other problems of metabolism.
He needs further evaluation like blood glucose, EEG, enzyme assays, and screening for other metabolic problems to look for the cause for this episode.
Therefore I suggest you to consult Nemours Hospital for children for further evaluation and management of the problem.
Hope I have answered your query, if you have any clarification please let me know.
Regards.
Needs further evaluation
Detailed Answer:
Hi XXXXXXX
Thank you for your query on Healthcare Magic.
The unresponsive episode of the child in the morning looks like a seizure episode or a hypoglycemic episode.
Seizures usually presents with involuntary movements or unconsciousness depending on the type of seizure followed by a state of unconsciousness and unresponsiveness(postictal state).
Whereas hypoglycemic episode (low blood glucose) will present with an episode of unresponsive state with or without seizures.
In some disorders like glycogen storage disorders children present with low blood glucose especially in the early morning because of over night fasting.
And seizures, hypoglycemic episodes tend to occur during sleep in the nigh times.
My opinion of cause for his unresponsiveness is a seizure episode or an episode of low blood glucose.
Presence of 4+ ketones in urine is abnormal and it denotes ketosis in the body which is seen in starvation, diabetic ketoacidosis, and glycogen storage disorders.
The raised WBC count and high neutrophil count is suggestive of infection or stress related.
The idea behind referring the child to geneticist could be for the evaluation to look for inborn errors of metabolism such as glycogen storage disorder or other problems of metabolism.
He needs further evaluation like blood glucose, EEG, enzyme assays, and screening for other metabolic problems to look for the cause for this episode.
Therefore I suggest you to consult Nemours Hospital for children for further evaluation and management of the problem.
Hope I have answered your query, if you have any clarification please let me know.
Regards.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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