Status Epilepticus Treatment (seizures treatment):-
Status Epilepticus, Seizures lasting for more than 30 minutes or recurrent seizures without full recovery in between episodes. Practically, a seizure of more than 5 minutes is treated as Status epilepticus.
Causes of seizures:
1.CNS infection
2.Hypoxic brain injury
3.Fever
4.Stroke
5.Head injury
6.Ecclampsia
7.Electrolytic abnormalities (low Na+, low Ca++, low Mg++, hypoglycemia, hyperglycemia)
8.Hyperthyroidism
9 .Congenital brain malformations
10.Genetics(PKU, Turner’s syndrome etc.)
11.Toxic metabolites (porphyria, uremia, liver failure)
12.Drug withdrawal
13.Drug interaction
Investigations:
RBS, SpO2, ABG, Ca++, Mg++, Na+, K+, CBC, Drug level, CSF examination, CT brain, Fundus examination
Status Epilepticus Treatment (seizures treatment):-
1.Place the patient in left lateral position
2.Oxygen inhalation
3.Draw blood/ check RBS/ monitor SpO2
4.If history and examination suggestive of hypoglycemia 100ml 25%dextroge
5.Control of Seizures:
A) Inj. Diazepam 5 mg iv stat (0.3mg/kg) over 2-5 minutes. Repeat only after 15 minutes if needed. OR Inj. Lorazepam 2mg iv stat over 1 minute by 2mg iv stat after 1minute 0.1mg/kg.
B.inj.phenytoin 20mg /kg at 50mg/minute-1g phenytoin in 500ml ns over 20 minutes
Or if fosphenytoin available same does, but at 100mg/minute
Maintenance dose: 10 mg/ kg q8h iv phenytoin
Note: if diazepam / lorazepam causes respiratory depression give pain stimulus because it does not cause analgesia
Side effects of phenytoin hypotension, heart block
(Check pulse regularly) do note give phenytoin in dextroge solution
If seizures continue, it is said to be refractory status epileptics
6. Step 2: Inj. Levetiracetam 2g in infusion over 30 minutes followed by 500mg iv q8h
7. Step 3: Inj. Valproate 30mg/ kg iv over 15minutes
8. Step 4: anaesthesia intubate, start eeg monitoring. Midazolam 0.2 mg/kg iv bolus, followed by continuous iv infusion 0.1 mg/ kg/ hour
Or propofol 1-2 mg/ kg iv loading dose followed by iv infusion 2mg/kg/hour+ pentobarbital 5mg/kg loading dose at 50mg/minute followed by 1mg/kg/hour.
Read more https://drrakeshukeymd.com/general-question-answer-drugs/
Follow us on Facebook- https://www.facebook.com/DrRakeshUkeyMD