|
| |
| Status Epilepticus
(SE) for Adult patient |
| Definition |
 | 30 minutes of continuous seizures or lack of recovery between discrete seizure
for focal, complex partial, absence and other form of convulsive seizure |
| 5 minutes of continuous convulsive seizures |
| 3 discrete convulsions within an hour |
|
| Overview |
| SE lasting longer than 60 minutes carried a mortality of
32% |
| Mortality is about 2.7% for a shorter duration. |
| SE caused by anoxia was associated with 70% mortality in adults |
|
| Management |
| Take care of ABC |
| Draw blood for
 | Electrolytes, CBC, Calcium, Magnesium, BUN, Liver function |
| Anticonvulsant level, Alcohol, Toxicology screen |
|
| If hypoglycemia suspected, give 50% glucose |
| Give Thiamine 100 mg iv |
| Lorazepam 0.1 mg/kg iv |
| Load with Fosphenytoin 20 mg/kg of Phenytoin
equivalent iv, not to exceed 150 mg/min. |
| Review lab result and correct any abnormality |
| For refractory seizure, need Intubation, EEG monitoring and
consider one of the following IV and or drip:
|
|
| Treat complications of SE |
| Rhabdomyolysis:
| maintain adequate urine output |
| Urinary alkalinization may be useful. |
| If treatment of GCSE takes longer than expected because of hypotension or arrhythmias, neuromuscular junction blockade under EEG monitoring
may be considered. |
|
| Hyperthermia:
| External cooling usually suffices if the core temperature remains elevated. |
| High dose pentobarbital generally produces
poikilothermia. |
|
| Treatment of cerebral edema secondary to SE has not been well studied.
| SE and cerebral edema may be caused by the same underlying condition. |
| Hyperventilation and mannitol |
| Edema due to SE is vasogenic in origin, so steroids may be useful. |
|
|
| Other Tests as indicated |
| CT/MRI: bleed, infection, AV malformations, neoplasm |
| Lumbar puncture: if CNS infection suspected |
| Blood cultures: Sepsis |
|
|
