Seizure Management

Question 1

Pharmacological management of seizures

Answer 1

If seizure ongoing within:

10 minutes: 4mg lorazepam IV or 10mg diazepam PR

20 minutes: repeat above

30 minutes: phenytoin 20mg/kg IV (+cardiac monitor)
OR levetiracetam 40mg/kg

60 minutes: GA in ICU

Question 2

What to give if suspicion of hypoglycaemia or alcohol dependence

Answer 2

50ml 50% glucose IV

Pabrinex 2 pairs IV

Question 3

What to do after patient has recovered consciousness

Answer 3

Find and treat cause:

• Cap glucose, VBG (lactate and acidosis), FBC, U&E, LFT, Ca, PO, Mg (electrolyte abnormalities), anti epileptic drug levels, clotting
• ECG (prolonged QT)
• Urine toxicology
• CT/MRI brain (SOL/bleed), EEG, LP (meningitis/encephalitis)

Refer to medical team / neurology

Give driving advice and instruct patient to inform DVLA

Question 4

Common causes of seizures

Answer 4

Neuro

• epilepsy
• SOL
• meningitis / encephalitis
• post-stroke
• trauma
• congenital abnormalities

Metabolic

• hypoglycaemia
• hyperuricaemia
• electrolyte abnormalities

Drugs

• overdoses
• drugs of abuse
• alcohol withdrawal
• toxins

Febrile convulsion

Eclampsia