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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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My Daughter Is 14 And Has Had Her Period For

my daughter is 14 and has had her period for 1 year. With the onset of menses we noticed that she would vagal out if she got up too fast. In April she had a syncopal episode lasting about 30 seconds and recovered on her own it should be noted this was day 1 of her menstrual cycle. Blood tests were done to see if any anemia or electrolytes were off. All was normal. at the end of May she had was struggling with idopathic hives. She has fair sensitive skin, had broke out in hives and had angioedema of her face. Benedryl and medroldose pack were perscribed. While on steroids it got better but after she was off they came back. a decadron injection IM was administered as we were to leave on vacation June 12. on the week prior to our vacation she had a very intense week of sports camps. June 8 she had a syncopal episode at church where we couldn't get her to wake up. Family doctor sent us to ER. On the way to ER pulse was thready and respirations were shallow and sporatic, she had a time where I wasn't able to feel a pulse in her wrist and she quit breathing, vigorous sternal rub did not stimulate her breathing, so a rescue breath was given and she gasped and resumed breathing. Upon reaching ER she was noted to have started having a seizure. She was also noted to have started to menstruate when she was straight cathed. UA was neg. All labs were normal. Blood sugar was 97. Fluid recesutation and 2 doses of Ativan and 1 of valium were given. She was transferred to Children's Hosp, where she was put on the tele unit, and monitored overnite, and had an EEG. Cardiology and Neurology, cleared her and ruled her to have neurocardiogenic vasovagel syndrome. She was dismissed with strict monitoring of her fluid intake and instructed to be sure to get at least 70 oz per day in and more if involved with sports. We were cleared for vacation so off to florida we went. While there she developed worsening angioedema face was unrecognizable and hands and feet were swelling also, Went to an ER, blood cultures and strep negative. IV decadron of 10mg was given and she was sent home on 10mg prednisone per day which was tapered off by her Asthma/Allergist when we got home. her allegra and singular was increased to BID and hives eventually stayed away and have not returned.
She has had 2 near sycopal episodes since where she was able to lay down put feet up and drink 20 oz of fluid to avert passing out. On 11-11 she was at school, day one of menses, didn't feel well went to office, layed down put feet up and I was called. Upon arrival I noticed she didn't look good. I was unable to get her to drink fluids as raising her head a touch was too much for her as she reported severe dizziness. I laid her head down and she shortly had another sncopal episode. 911 was called, while waiting for them to arrive she started seizure activity again, paramedic started fluids at scene with large bore IV with NS wide open. In squad she was given 1 dose of 1mg of Ativan. After 3 minutes and no change and respiration were not adequate, jaw thrust was done to keep her tongue out of her way. she was then able to keep her o2 sat up. She was given a 2nd dose of 1mg of Ativan. Upon arriving in ER blood sugar was 61. NS was changed to D5W and reduced to 200ml/hr. She then started to be conscious. A few hours later we were released and sent home to monitor blood sugar. Nothing abnormal has shown up. Endocrinology was consulted from ER by phone and told to start her on ortho tricycline. No transfer was done. We were dismissed and I was not content with the ambiguity of the cause of her episodes. I called her pediatrician who lives in a larger town and he has ordered cortisol levels to be checked. I am wondering if the stent of steroids could have caused adrenal insufficiency? And is that enough to cause the syncopal episodes to escalate into seizure activity? And is her day 1 of her cycle flucuation of hormones what is the trigger to all of this????
posted on Sun, 22 Nov 2015
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