ABSTRACT. A grand mal seizure is an unexpected, rare adverse event in a child receiving eye drops to dilate the pupils for an eye examination. A case is reported of a convulsion in a 23-month-old boy after he received Cyclogyl (cyclopentolate) and Neo-Synephrine (phenylephrine) eye drops before ophthalmoscopy. His serum sodium was 125 mEq/L, and he had low plasma pseudocholinesterase activity. Children exposed to organophosphate insecticides and other pseudocholinesterase inhibitors may be at risk for cyclopentolate toxicity. Pediatrics 2004;113:e499 -e500. URL: http://www.pediatrics.org/cgi/ content/full/113/5/e499; seizures, cyclopentolate, eye drops. P atients undergoing ophthalmoscopy in hospital for various reasons are given eye drops often for cycloplegia and mydriasis to facilitate examination of the retina. The agents commonly used are 10% phenylephrine eye drops to dilate the pupils and Cyclogyl (cyclopentolate) in the form of 0.5% or 1% eye drops to paralyze the iris (cycloplegia) temporarily. Cyclogyl is a muscarinic receptor antagonist similar to atropine. It shares certain rarely occurring side effects with atropine, which include the possibility of epileptic seizures. We present the case of a toddler without a prior history of seizures that had a grand mal seizure lasting 30 minutes after he got 1 drop in each eye, every 5 minutes, of 10% Neo-Synephrine and 1% Cyclogyl, for a total of 3 drops of each over a 15-minute period. His seizures began 45 minutes after he received the last dose of each eye drop. CASE REPORTA previously healthy 23-month-old white male infant came by ambulance to the hospital because of second and third degree scald burns involving both feet and ankles in stocking distribution. This injury was incurred by his being immersed at 6 pm in a tub of hot water. He was brought to a local emergency department by his mother 4 2 ⁄3 hours after the accident (she said she had been told by phone to wait and see whether his feet became blistered and swollen before coming in). He was triaged, stabilized, and burn-dressed in the local emergency department and transferred by ambulance to this hospital for treatment in our burn center.He arrived at our emergency department ϳ7 3 ⁄4 hours after the scalding. His temperature was 37.6°C, his pulse was 160 beats per minute, and his respirations were 32 per minute. He was crying, withdrawn, and in pain. He didn't talk. His weight was 11.88 kg (25th percentile), height was 93 cm (a little less than the 95th percentile), and head circumference was 49 cm (50th percentile). He showed a normal physical examination, except for a diaper rash, and a normal neurologic examination. There was no external evidence of head trauma or other trauma apart from the scald burns involving both feet and ankles in a stocking distribution. Some were of partial thickness, but most were full thickness.The local emergency department had referred his case to the City of New York Child Protective Services before he was transferred.In our emergency department he was given 1 mg o...

During a routine diagnostic cytogenetic study of the marrow of a child with Down’s syndrome, a minor line of cells with a complement of 50 chromosomes was discovered. The predominant cell in marrow and blood had 47 chromosomes with the standard trisomy in Group 21-22. Although anemia and thrombocytopenia were present, other diagnostic criteria of leukemia did not appear until several weeks later. It is proposed that careful cytogenetic studies combined with serial clinical evaluation may disclose important relationships between chromosomal mutation, aneuploid stemlines, and the production and evolution of neoplasms.