Objective:

To evaluate whether admission serum total carbon dioxide (TCO2) predicts seizure recurrence within 48 hours in children with benign convulsions associated with mild gastroenteritis (CwG), highlighting its potential clinical significance.

Key Findings:

• Of 86 children, 23 (26.7%) experienced seizure recurrence.
• Median TCO2 was significantly higher in the recurrence group (17.4 vs. 15.1 mmol/L, P = 0.007).
• Higher TCO2 (odds ratio 1.235, 95% CI 1.053–1.448, P = 0.009) and younger age (P = 0.016) were independently associated with recurrence.
• A TCO2 cutoff of 16.25 mmol/L yielded 78.3% sensitivity and 61.9% specificity.
• Strong correlation between venous TCO2 and arterial bicarbonate (r = 0.966, P < 0.001).

Interpretation:

Higher admission serum TCO2 is independently associated with early seizure recurrence in CwG, suggesting it may serve as a candidate biomarker for risk stratification, with important clinical implications.

Limitations:

• The study is retrospective and conducted at a single center, which may introduce biases.
• Findings require external validation in prospective cohorts.

Conclusion:

TCO2 may represent a readily accessible biomarker for guiding observation in pediatric patients with CwG, emphasizing the need for further research to validate these findings.