Status Epilepticus
- This
is a true neurologic emergency!
Prolonged seizures can irreversibly damage the brain!
- Definition:
- Greater
than 30 minutes of continuous seizures of 2 or more sequential seizures
without full recovery of consciousness
- Etiology:
- Withdrawal
from anticonvulsants
- Cerebrovascular disease
- Alcohol
related causes
- Metabolic
disturbances
- Hemorrhage
- Infection
- Hypotension
- Tumor
- Anoxia
- Treatment:
- Airway/oxygenation
are first priority
- R/O
hypoglycemia (finger stick)
- Give
thiamine and D50
- Check
electrolytes
- Load
anticonvulsant
- Dilantin 18 mg/kg – no faster than
50 mg/min; or
- Phenobarbital
20 mg/kg as fast as BP will allow
- Give
benzodiazapine (valium/ativan)
if seizure continues
- If
seizures persist, rebolus anticonvulsant
- Dilantin 5 mg/kg to total dose of
30 mg/kg
- Transfer
to ICU
- Consider
second anticonvulsant
- Call
Neurology consult
- Will
likely require continuous EEG monitor
- If
seizures still continue, pentobarbital coma may be used
- Pentobarb 5 mg/kg load, then .5 to 3
mg/kg/hr to burst suppression pattern on EEG or level of 3-4 mg%
- Once
seizures controlled, imaging to R/O structural lesion
- JAMA
270:854; 1993.