Status epilepticus Flashcards
define status epilepticus?
single continuous seizure ≥ 5 minutes
is it a medical emergency?
yes
deficiency in which vitamin can cause status epilepticus?
Thiamine deficient
Thiamine is a natural anti-convulsant
which electrolyte abnormality can cause status epilepticus?
-2
why?
-2
hyponatremia
hypocalcaemia
hyponatremia causes cerebral oedema
hypocalcaemia paradoxically increases neuronal excitability
which drink can cause status epilepticus?
why?
alcohol
↑alcohol –> hypoglycaemia –> influx Na+ K+ into brain cells –> brain osmolality [] –> cerebral oedema –> seizure
which compound in coffee increases risk of status epilepticus?
caffeine
which drug used in COPD increases risk of status epilepticus?
theophylline
RF for status epilepticus?
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
which age groups are risk factors for status epilepticus?
Children or elderly
symptoms and signs of status epilepticus?
-6
Tonic-clonic seizure Tongue biting lip smacking Urinary incontinence Lose consciousness Post-ictal
Complications of status epilepticus?
Aspiration pneumonia – swallowed saliva Cardiac arrhythmias Cardiac arrests Rhabdomyolysis - renal failure Hypoglycaemia Cerebral oedema
heart complications of status epilepticus?
Cardiac arrhythmias
Cardiac arrests
endocrine complications of status epilepticus?
-1
Hypoglycaemia
after status epilepticus has stopped what Ix do you do on pt and why/what are you looking for?
-5
ECG – cardiac arrhythmias
ABG – metabolic acidosis with raise lactate
Metabolic screen – electrolyte and glucose levels
U&E - electrolyte levels
LFT
FBC
homeless person comes with status epilepticus.
what extra Ix would do here?
what you looking for?
Toxicology screen – alcohol, cocaine
1st line acute Mx for status epilepticus.
ABCDE
what drug do you give to pt having status epilepticus in a non-hospital setting?
- 2 named drugs
- routes
Rectal diazepam
or buccal midazolam
what drug do you give 1st line to pt having status epilepticus in the hospital?
- name
- route
lorazepam
IV
pt in hospital with ongoing status epilepticus.
(1st line drug did not help.)
what drugs do you try now?
-2
group of these drugs?
Phenytoin or
Phenobarbital
anticonvulsants
pt has refractory status epilepticus (all meds been tried and failed).
who do you refer to now?
what will they do?
-3 main things
call anaesthetist
General anaesthesia for 12-24hours
With intubation & EEG monitoring
pt having status epilepticus due to excess alcohol drinking.
what extra things would give to this pt?
-2
IV Pabrinex(B1) & glucose
status epilepticus mortality rate?
3%
phenytoin moa?
Na+ channel blocker
Phenobarbital moa?
stimulates GABA receptors
in terms of Mx what does the acronym O M L P A stand for?
O – o2 M – midazolam L – lorazepam P – phenytoin A – anaesthetist
