USMLE Forum Archives - USMLE Step 3 - Status Epilepticus
Status Epilepticus
meduploader - 05-15-09 14:08
Traditionally defined as (1) continuous seizure activity lasting > 30 minutes, or (2) recurrent seizures without return of normal consciousness between seizures. Practically speaking, seizure activity lasting > 5 minutes is unlikely to remit spontaneously and carries the risk of permanent neuronal injury. Generally,
ongoing or recurrent seizure activity lasting > 5 minutes is thus considered a medical emergency and treated as status epilepticus.
TREATMENT
Treatment guidelines are as follows:
ABCs.
Labs: Draw labs for metabolic abnormalities (e.g., glucose, sodium, calcium).
Pharmacologic:
Administer thiamine and glucose.
Benzodiazepines are first-line anticonvulsants for status epilepticus. Give lorazepam 0.1 mg/kg IV at 1–2 mg/min.
Fosphenytoin (20 mg/kg “phenytoin equivalents” IV at 150 mg/min) should then be started immediately even if seizures terminate with lorazepam.
If seizures persist, the next step is to give a second load of phenytoin or fosphenytoin using an additional 5–10 mg/kg IV load or move directly to the next step.
If seizures continue, the next step is to administer pentobarbital, midazolam, or propofol. Use of any of these medications typically requires continuous EEG recordings, mechanical ventilation, and cardiac pressors.
meduploader - 05-15-09 14:08
Traditionally defined as (1) continuous seizure activity lasting > 30 minutes, or (2) recurrent seizures without return of normal consciousness between seizures. Practically speaking, seizure activity lasting > 5 minutes is unlikely to remit spontaneously and carries the risk of permanent neuronal injury. Generally,
ongoing or recurrent seizure activity lasting > 5 minutes is thus considered a medical emergency and treated as status epilepticus.
TREATMENT
Treatment guidelines are as follows:
ABCs.
Labs: Draw labs for metabolic abnormalities (e.g., glucose, sodium, calcium).
Pharmacologic:
Administer thiamine and glucose.
Benzodiazepines are first-line anticonvulsants for status epilepticus. Give lorazepam 0.1 mg/kg IV at 1–2 mg/min.
Fosphenytoin (20 mg/kg “phenytoin equivalents” IV at 150 mg/min) should then be started immediately even if seizures terminate with lorazepam.
If seizures persist, the next step is to give a second load of phenytoin or fosphenytoin using an additional 5–10 mg/kg IV load or move directly to the next step.
If seizures continue, the next step is to administer pentobarbital, midazolam, or propofol. Use of any of these medications typically requires continuous EEG recordings, mechanical ventilation, and cardiac pressors.
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Re: Status Epilepticus mtniharika - 10-05-09 14:37 This condition is most common in known epileptics. Within known epileptics, it can be caused by:
Insufficient dosage of a medication already prescribed to the patient. Such causes of this include:
o Forgetfulness on the part of the patient in taking scheduled doses, or failure to take doses at the scheduled times
o Dislike of the medication or its side effects
o Patient's rationing of the medication. This is usually due to patient's difficulty in affording medication, or temporary or permanent lack of access.
o Failure to maintain a therapeutic level following a change in a patient's physiological needs. This may be the result of a patient growing (into adolescence or adulthood), gaining weight, pregnancy, or childbirth.
Sudden withdrawal from a seizure medication. Such causes include:
o Sudden lack of access to medication due to unexpected circumstances
o Lack of ability of patient to communicate medication needs to others, leading to absence of doses
o Physician's decision to discontinue medication
Consumption of alcoholic beverages while on an anticonvulsant, or alcohol withdrawal. For this among other reasons, most patients who have active seizure disorders or who are on anticonvulsants are advised to altogether avoid consuming alcohol.
Dieting or fasting while on an anticonvulsant. Those with epilepsy or who are on anticonvulsants are advised to consult with their physicians prior to dieting or fasting.
Consuming certain food products that interact badly with an anticonvulsant (rare)
Starting on a new medication that reduces the effectiveness of the anticonvulsant
Developing a resistance to an anticonvulsant already being used
Injury to the patient. This may be the result of a sports injury, motor vehicle accident, fall, physical abuse, or other injury that affects the brain. Though such injuries may trigger a seizure in anyone, those with a known seizure disorder are more susceptible.
Gastroenteritis while on an anticonvulsant. This is because the digestive system may force out the anticonvulsant, thereby rendering the body with a lack of protection.
Developing a new, unrelated condition in which seizures are coincidentally also a symptom, but are not controlled by an anticonvulsant already used
Metabolic disturbances such as affected kidney and liver
This condition may also occur as the first known seizure in new epileptics, accounting for about 10% of cases. In non-epileptics, causes may include:
Brain disorders, such as:
o Meningitis
o Encephalitis
o Brain tumors
o Abscess
o Traumatic brain injury
Sepsis
Some autoimmune disorders
Extremely high fever, especially in children
Low glucose levels
Eating disorders
Nerve agents such as soman
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