CWH X C1322679

 A

Based on your description, here’s a structured differential diagnosis (DDx) for this 1-year-old girl with a brief episode of cyanosis/LOC, hypotonia, eye-rolling, and post-episode vomiting:

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Key Features of the Episode

• Age: 1 year

• Timing: ~15 min post dinner

• Event: Lips going grey/blue, floppiness, eye-rolling, LOC <5 min

• Associated: Projectile vomiting post-episode

• Recovery: Slow return to baseline

• Vitals during assessment: Tachycardic, no respiratory distress, normoglycemic

• Previous similar episode: 6th July (seen in A/E)

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Top 3 Differential Diagnoses (DDx)

1. Gastroesophageal reflux-related event / Vomiting-induced cyanotic/ALTE episode (Now often called BRUE – Brief Resolved Unexplained Event)

   • Mechanism: Sudden vomiting → airway obstruction or vagal response → cyanosis, hypotonia, LOC

   • Supporting features: Post-prandial, projectile vomiting after episode, age typical (<1–2 yrs)

   • Usually brief, full recovery, can recur

2. Seizure (possibly gastro-induced or reflex seizure)

   • Mechanism: Post-prandial metabolic/neuronal trigger → tonic-clonic or atonic episode

   • Supporting features: Eye-rolling, floppiness, LOC

   • Vomiting can occur post-ictally

   • Needs EEG for confirmation if recurrent or atypical features

3. Cardiac cause (arrhythmia, congenital heart disease with transient cyanotic spell / supraventricular tachycardia)

   • Mechanism: Intermittent arrhythmia → transient hypoperfusion → LOC & cyanosis

   • Supporting features: Tachycardia during exam, abrupt onset, short duration

   • Less likely if completely normal cardiovascular exam and no structural heart disease history

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Other Considerations

• Respiratory obstruction: Laryngospasm, choking episode – less likely if breathing throughout

• Metabolic causes: Hypoglycemia – excluded (BM okay)

• Neurological events: Rare: migraine variants, vestibular syncope – less likely

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Red Flags / Next Steps

• Recurrent episodes or prolonged LOC (>1–2 min)

• Seizure features (tonic-clonic, post-ictal confusion)

• Cardiac work-up: ECG, Holter, echocardiography if cyanosis/arrhythmia suspected

• Referral for pediatric neurology if seizures suspected

• Educate parents on monitoring and emergency response

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💡 Summary:
Most likely: Brief Resolved Unexplained Event (BRUE) related to post-prandial vomiting / reflex event.
Other top considerations: Seizure and intermittent cardiac arrhythmia.

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If you want, I can make a concise one-page table with features, supportive signs, and investigations for the top 3 DDx—perfect for quick clinical reference. Do you want me to do that?

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