status epilepticus

Question 1

16 y.o. girl with known epilepsy brought to hospital by mum

girl is having a prolonged tonic-clonic seizure

mum is very anxious as seizure has lasted more than 30 mins

(a) dx?

Answer 1

status epilepticus

Question 2

(b) girl’s mum says daughter has been going through ‘a difficult stage’ and unsure if she has been taking her anti-epileptic medication regularly.

suggest 3 other causes for this presentation?

Answer 2

1. hypoglycaemia
2. encephalitis
3. SOL
4. hypocalcaemia
5. pregnancy
6. sudden anti-convulsant withdrawal
7. drug overdose

Question 3

(c) you obtain IV access immediately and send off urgent bloods.

suggest 3 important blood tests in this situation.

Answer 3

1. Glucose
2. FBC
3. Calcium
4. U+Es
5. LFTs
6. toxicology screen
7. anti-convulsant levels
8. blood and urine cultures

Question 4

(d) what 2 immediate treatments will you institute?

Answer 4

1. IV glucose 50% 50ml (unless BM is normal)
2. IV lorazepam 4mg

Question 5

(e) the girl is still fitting so you start an IV infusion.

what is your drug of choice?

Answer 5

phenytoin