Seizure

Question 1

How long should you wait during a seizure before administering diazepam

Answer 1

5 min

Question 2

Dose and route of diazepam to control seizure in children

Answer 2

0.5 mg/kg rectally ( max- 10 mg)

IV- 0.3 mg/kg over 3 min ONLY if ambu bag and mask are available ( as respiratory depression can occur)

Question 3

Dose and route of diazepam to control seizure in adults

Answer 3

10 mg rectally or slow IV

Question 4

How will you treat status epilepticus ( seizure > 30 min) in a) children
b) adults

Answer 4

a) Children- 5ml/kg 10% glucose over 3 min

b) Adult- 1ml/kg 50% glucose over 5 min

Question 5

First line of treatment of Generalized Tonic Clonic Seizures in children < 2 years

Answer 5

a) Carbamazepine

b) Phenobarbital

Question 6

Dose of carbamazepine in children < 2 yrs

Answer 6

5mg/kg/od or 2.5 mg/kg/bd ( increase by 2.5 -5 mg/kg every week) upto 5mg/kg/bd or tid ( max 20mg/kg/day)

Question 7

Dose of phenobarbital in children < 2 years

Answer 7

Initially- 3-4mg/kg od (bedtime) increase upto 8mg/kg od

Question 8

First line of treatment of Generalized Tonic Clonic Seizures in children> 2 yrs/ adults

Answer 8

a) Carbamazepine

b) Sodium valproate

Question 9

Dose of carbamazepine in children>2 yrs, adults

Answer 9

initial 100-200 mg od/bd,
increase by 100-200 mg every week
upto 400 mg bd/tid ( max 1600 mg)

Question 10

Dose of sodium valproate in children> 2 years and adults

Answer 10

children > 20 kg initial 200mg bd ( regardless of weight)
increase upto 15mg/kg bd
Adults
initial 300 mg bd
increase by 200 mg every 3 days
upto 500mg/ 1g bd

Question 11

How will you give a rectal injection

Answer 11

Use a syringe without a needle or a nasogastric tube (CH8) to a length of 2-3 cm attached to the tip of a syringe

Question 12

Upto what age are febrile seizures considered to be ‘safe’ ie don’t cause complications

Answer 12

3 yrs

Question 13

How will you treat eclampsia

Answer 13

a)magnesium sulfate ( 5 g ampule, 500mg/ml, 10ml)- by iv infusion. 4g diluted in 0.9% saline given in 15 minutes followed by 1g/ hr.
Continue giving mag sulf for 24 hrs following delivery or last seizure
b) Nursing, hydration
c) Oxygen 4-6 L/min
d) Urgent delivery within 12 hrs

Question 14

How will you monitor the patient who is being treated with magnesium sulfate?

Answer 14

Monitor patellar tendon reflex every 15 min. IF the patient has malaise, drowsiness, difficulty speaking or loss of patellar reflex, then stop magnesium sulfate and inject calcium gluconate 1gm by slow DIRECT IV injection ( over 5-10 min)

Question 15

How will you treat eclampsia in the absence of magnesium sulfate

Answer 15

Use diazepam 10mg slow iv followed by 40mg in 500 ml 5% glucose as a continuous infusion over 24 hrs
If no IV access give 20 mg rectally
IF treatment fails after 10 min give another dose of 10 mg
For direct IV or rectal administration dilute diazepam in 5% gluocse or 0.9% saline to make a total volume of 10ml