<prompt> A 5-year old child of severe nephrotic syndrome on treatment with tacrolimus, frusemide and prednisolone developed seizures. The investigations revealed:Serum Na 136 mEqLBlood urea 78 mgdLSerum creatinine 0.5 mgdLSerum albumin 1.5 gdLSerum total Ca 7.5 mgdLUrine albumin 2gWhat is the likely cause of symptoms in this baby?HypocalcemiaTacrolimus toxicityUremiaHyponatremia  <response>: To get to the answer, we will look at the options one by one.HypocalcemiaSerum calcium in this boy is 7.5 mgdL. Hypocalcemia can result in seizures but the level should be very low. Further, if we correct calcium with serum albumin, it will come in normal range. Corrected calcium level in the serum can be calculated by adding 0.8 mgdL With every 1.0 gdL decrease in serum albumin below the normal value of 4.0 gdL. Hence, in this patient, corrected serum calcium level will be7.5 0.8 x 4.0 - 1.5 9.5 mg dLIt is in the normal range 8.5-10.5 mgdL and thus cannot be the cause of seizures in this person.UremiaAlthough blood urea is elevated 78 mgdL as compared to normal value of 15-40 mgdL but serum creatinine is normal 0.5 mgdL. For diagnosis of uremia, serum creatinine must be 3 times the normal value. Thus, uremia cannot be the answer.HyponatremiaSerum sodium is at lower normal value 136-152 mEqL. For causing seizures, serum sodium should be less than 125 mEqL. Therefore, this option can also be ruled out.Tacrolimus toxicityThis child is on tacrolimus therapy. It is a known neurotoxin and can cause seizures. It also can cause renal failure. Further by ruling out other options, the most likely cause seems to be tacrolimus toxicity. 