Serum Uric Acid as a Predictive Factor for Rotaviral or Noroviral Benign Convulsions with Mild Gastroenteritis

Abstract

Convulsions are a common problem in children. Benign convulsion with mild gastroenteritis (CwG) was first reported in Japan in 1982 [1], and is defined as an afebrile convulsion accompanied by symptoms of gastroenteritis in a child without a previous history of neurological disease or electrolyte abnormalities, moderate to severe dehydration, or metabolic acidosis. Longterm prognosis is favorable without serious sequelae. Most cases of CwG have been described in patients with rotavirus infection Purpose: This study investigated the relationship between serum uric acid levels and benign convulsions with mild gastroenteritis (CwG) caused by rotavirus and norovirus. Methods: This retrospective study identified 89 patients with CwG at Inha University Hospital from January 1999 to December 2019. We analyzed serum uric acid levels in patients with CwG and in patients with acute gastroenteritis without seizures according to the causative virus. Results: Among the 2,790 patients with rotavirus or norovirus gastroenteritis, 89 patients (3.2%) were diagnosed with CwG. The serum uric acid levels were significantly higher in CwG patients than in acute gastroenteritis patients (8.20±2.34 mg/dL vs. 5.44±2.69 mg/dL, P<0.001). When examined according to the virus type, serum uric acid levels were higher in the CwG group than in the acute gastroenteritis group in patients with rotavirus (8.05±2.48 mg/dL vs. 5.48±2.78 mg/ dL) and norovirus (8.43±2.13 mg/dL vs. 5.31±2.36 mg/dL) infections (P<0.001). However, there were no significant differences in uric acid levels between patients with CwG caused by rotavirus and those with CwG caused by norovirus. Conclusion: Patients with CwG, caused either by rotavirus or norovirus, showed significantly higher serum uric acid levels than those with acute gastroenteritis without seizures. Elevated serum uric acid levels could be a useful indicator for diagnosing CwG.

Epidemiology of Rotavirus Gastroenteritis and Rotavirus-Associated Benign Convulsions with Mild Gastroenteritis after the Introduction of Rotavirus Vaccines in South Korea: Nationwide Data from the Health Insurance Review and Assessment Service

“…A recent study found that an elevated level of serum uric acid is a factor for CwG [36]. In this study, we demonstrated that factors such as age and geographic location influenced RVGE and RaCwG differently; therefore, the prevalence of RaCwG is likely affected by various factors.…”

Benign Convulsions with Mild Rotavirus and Norovirus Gastroenteritis: Nationwide Data from the Health Insurance Review and Assessment Service in South Korea

“…Therefore, factors associated with the residence of the patients may affect the ratio of RaCwG to RVGE and NaCwG to NVGE. Furthermore, uric acid can be used as a diagnostic index for RaCwG; therefore, the effects of uric acid on the ratio of RaCwG to RVGE should be considered [ 47 ]. The ratio of NaCwG to NVGE consistently increased regardless of rotavirus vaccination.…”

Update on benign convulsions with mild gastroenteritis

“…11,17,30) Se-veral studies demonstrated that CwG may be associated with hyperuricemia or hyponatremia. 29,34,37) A recent study found that severe ketosis occurring in patients with CwG is associated with lower blood glucose and sodium levels. 35) Serum aspartate aminotransferase levels were elevated in patients with RaCwG compared with patients with RVGE without seizures or patients with febrile seizure associated with RVGE.…”

“…Although one of the characteristics of CwG is no abnormal findings in laboratory tests, some authors have conducted research with broader characteristic criteria of CwG [ 11 , 17 , 30 ]. Several studies demonstrated that CwG may be associated with hyperuricemia or hyponatremia [ 29 , 34 , 37 ]. A recent study found that severe ketosis occurring in patients with CwG is associated with lower blood glucose and sodium levels [ 35 ].…”