A six-year-old child is admitted to the Paediatric ICU for seizures. He has been on treatment with Tacrolimus and Prednisolone. On investigations his blood urea is 68 mg/dl, Serum Sodium is 136 meq/l likely cause of his seizures –: (A) Uremia, (B) Hyponatremia, (C) Hypocalcemia, (D) Tacrolimus Toxity
Answer is D. Tacrolimus neurotoxicity is an established cause for 'seizures' and the most likely reason for seizures in this child.
In hyponatremia, seizures usually develop when sodium levels decrease below 125 meq/L.
In hypocalcaemia, seizures develop when calcium level is below 6 mg/dl.
Uremic seizures occur late after delirium, hallucinations and agitation.