Status epilepticus

Question 1

what is status epileptics?

Answer 1

seizure that lasts > 5 minutes or recurrent without regaining consciousness in-between (min 2 seizures)

Question 2

what are the biochemical changes that occur in status epileptics?

Answer 2

hypoxia
hyperthermia
hypoglycaemia
increase lactate 
increase glutamate

Question 3

what are the possible aetiologies of status epileptics?

Answer 3

epilepsy 
febrile seizure 
infection 
cerebral haemorrhage 
stroke 
electrolyte disturbance (hyponatraemia, hypocalcaemia)
alcohol induced 
elicit drug use

Question 4

what investigations are important in status epileptics?

Answer 4

bedside:

• blood glucose
• ECG

bloods:

• ABG
• FBC: possible infection
• electrolytes
• anti epileptic drug levels
• drug test

imaging:
- CT head

specialist tests:

• LP
• EEG

Question 5

what is the 1st line management of status epilepticus?

Answer 5

ABCDE approach

Question 6

what is the medical management of status epileptics?

Answer 6

early (< 10 mins)
- IV lorazepam 4mg

persistant (10 - 60 mins)

• phenytoin 15-18mg/kg
• or phenybarbital 15mg/kg bolus

refractory (60-90 mins)
- general anaesthetic with propofol, thiopentone, midazolam

Question 7

what is the medical management of status epileptics in children ?

Answer 7

> 5 mins
- IV lorazepam

> 15 mins
- repeat IV lorazepam

> 25 mins
- phenytoin or phenobarbital if already on phenytoin

> 45 mins
- anaesthesia with thiopental

Question 8

what are the acute complications of status epileptics?

Answer 8

hyperthermia
pulmonary oedema
cardiac arrythmia
cardiovascular collapse

Question 9

what are the late complications of status epileptics?

Answer 9

epilepsy

neurological deficit