Status epilepticus

Question 1

define status epilepticus?

Answer 1

single continuous seizure ≥ 5 minutes

Question 2

is it a medical emergency?

Answer 2

yes

Question 3

deficiency in which vitamin can cause status epilepticus?

Answer 3

Thiamine deficient

Thiamine is a natural anti-convulsant

Question 4

which electrolyte abnormality can cause status epilepticus?
-2

why?
-2

Answer 4

hyponatremia
hypocalcaemia

hyponatremia causes cerebral oedema
hypocalcaemia paradoxically increases neuronal excitability

Question 5

which drink can cause status epilepticus?

why?

Answer 5

alcohol

↑alcohol –> hypoglycaemia –> influx Na+ K+ into brain cells –> brain osmolality [] –> cerebral oedema –> seizure

Question 6

which compound in coffee increases risk of status epilepticus?

Answer 6

caffeine

Question 7

which drug used in COPD increases risk of status epilepticus?

Answer 7

theophylline

Question 8

RF for status epilepticus?

Answer 8

Epilepsy
Children or elderly
Poor compliance with anti-epileptic meds -most common cause
Alcoholism
Rec drugs, cocaine
Previous neuronal injury: head trauma, stroke, haemorrhage, brain tumour
Electrolyte imbalances

Question 9

which age groups are risk factors for status epilepticus?

Answer 9

Children or elderly

Question 10

symptoms and signs of status epilepticus?

-6

Answer 10

Tonic-clonic seizure 
Tongue biting 
lip smacking
Urinary incontinence 
Lose consciousness 
Post-ictal

Question 11

Complications of status epilepticus?

Answer 11

Aspiration pneumonia – swallowed saliva 
Cardiac arrhythmias 
Cardiac arrests 
Rhabdomyolysis - renal failure 
Hypoglycaemia 
Cerebral oedema

Question 12

heart complications of status epilepticus?

Answer 12

Cardiac arrhythmias

Cardiac arrests

Question 13

endocrine complications of status epilepticus?

-1

Answer 13

Hypoglycaemia

Question 14

after status epilepticus has stopped what Ix do you do on pt and why/what are you looking for?
-5

Answer 14

ECG – cardiac arrhythmias
ABG – metabolic acidosis with raise lactate
Metabolic screen – electrolyte and glucose levels
U&E - electrolyte levels
LFT
FBC

Question 15

homeless person comes with status epilepticus.

what extra Ix would do here?

what you looking for?

Answer 15

Toxicology screen – alcohol, cocaine

Question 16

1st line acute Mx for status epilepticus.

Answer 16

ABCDE

Question 17

what drug do you give to pt having status epilepticus in a non-hospital setting?

• 2 named drugs
• routes

Answer 17

Rectal diazepam

or buccal midazolam

Question 18

what drug do you give 1st line to pt having status epilepticus in the hospital?

• name
• route

Answer 18

lorazepam

IV

Question 19

pt in hospital with ongoing status epilepticus.

(1st line drug did not help.)

what drugs do you try now?
-2

group of these drugs?

Answer 19

Phenytoin or
Phenobarbital

anticonvulsants

Question 20

pt has refractory status epilepticus (all meds been tried and failed).

who do you refer to now?

what will they do?
-3 main things

Answer 20

call anaesthetist

General anaesthesia for 12-24hours
With intubation & EEG monitoring

Question 21

pt having status epilepticus due to excess alcohol drinking.

what extra things would give to this pt?
-2

Answer 21

IV Pabrinex(B1) &
glucose

Question 22

status epilepticus mortality rate?

Answer 22

3%

Question 23

phenytoin moa?

Answer 23

Na+ channel blocker

Question 24

Phenobarbital moa?

Answer 24

stimulates GABA receptors

Question 25

in terms of Mx what does the acronym 
O
M
L
P
A
stand for?

Answer 25

O – o2 
M – midazolam 
L – lorazepam 
P – phenytoin 
A – anaesthetist