6 May 2012

Status Epilepticus

Status epilepticus is defined as recurrent or continuous seizure activity lasting longer than 30 minutes in which the patient does not regain baseline mental status. Prolonged seizures are associated with cerebral hypoxia, hypoglycemia, and hypercarbia and with concurrent and progressive lactic and respiratory acidosis. Neuronal destruction can occur and may be irreversible,

Manangement
  1. Secure airway and suction
  2. High-flow 100% O2 by mask. Pulse oximetry.
  3. Establish IV access (if unsuccessful, give rectal diazepam)
  4. Check capillary blood glucose (and treat hypoglycaemia)
  5. Drugs (Diazepam PO/PR at t=0; may repeat at 5 min; Phenytoin infusion at 10 min)
  6. Recovery position
T=0 min
Diazepam (Valium, Diazemuls)
0.3 mg/kg IV over 1 min
or 0.4 mg/kg PR
May cause apnoea and hypotension.
T=5 min
Diazepam (Valium, Diazemuls)
0.3 mg/kg IV over 1 min
or 0.4 mg/kg PR
As above
T=10 min
Phenytoin (Epanutin)
18 mg/kg (max 1g) IVI over 30-45 min
Dilute in N Saline (max concentration 10mg/ml). Infusion rate not greater than 1mg/kg/min. Monitor ECG and BP
If status epilepticus persists despite phenytoin, call anaesthetist (for rapid induction anaesthesia with Thiopentone 4mg/kg IV). Monitor vital functions. Take CBC, U&E, Creatinine, ABG’s, RBG and Calcium.