Write short note on status epilepticus.
Or
Write management of status epilepticus.
Or
Outline the management of status epilepticus.
Answer. Status epilepticus is an alternate period of convulsions and unconsciousness without any intervening normal period.
It is a medical emergency because if not rapidly controlled it may be fatal.
It is most commonly referred to the tonic clonic seizures.
Status epilepticus is never the presenting feature of idiopathic epilepsy but may be precipitated by:
- Abrupt withdrawal of antiepileptic drugs.
- Structural lesion in brain
- Acute metabolic disturbance.
Read And Learn More: General Medicine Question And Answers
Status Epilepticus Clinical Features
- Status epilepticus is divided into four stages depending on the duration for which seizures continue.
- Prodromal phase: In patients with established epilepsy,tonicclonic status epilepticus seldom develops without warning.
There is usually a prodromal stage in which seizures become more frequent.
Early status: Once status epilepticus has been developed the fist 30 minutes comprised of early stage. - Established status: It is a status which has continued for 30min inspite of early stage treatment.
- Refractory status: The stage is reached, if seizures continue for 60 to 90 min after initiation of therapy.
Status Epilepticus Management
General and immediate measures:
- Move away the person from danger such as fie, water,machinery, etc.
- After convulsions cease, turn into recovery position.
- Ensure clear airway
- Do not insert anything in the mouth.
- If convulsions continue for more than 5 minutes urgent medical attntion is required.
- Patient should not be left alone until he is recovered.
- Establish intravenous access in large veins. Take blood for electrolytes, glucose, calcium, magnesium,full blood count, antiepileptic drug levels, alcohol and toxicology screen and cultures as appropriate.
- Urea and electrolytes, blood glucose, calcium and phenytoin levels are obtained urgently.
- Check glucose and immediately correct any hypoglycemia with 50% glucose up to 50 mL I.V. over 1 to 2 min in a large vein.
- If poor nutrition or alcohol abuse is suspected,administer thiamine 250 mg IV over 10min.
- Check for the blood gases.
Status Epilepticus Pharmacological management
- Lorazepam 4 mg IV over 2–3 minutes or IV Diazepam 5 mg IV. Repeat dose, if necessary. If IV access not possible give Midazolam 10 mg intranasally or IM.
- Give IV phenytoin 15–20 mg/kg or IV Fosphenytoin
20 mg/kg in infusion at rate of less than 50 mg/min (phenytoin). - Alternatives to IV phenytoin are Valproate 500–1000 mg IV bolus or Levetiracetam 1gm bolus.
Refractory status—if seizures continue (more than 20 minutes), then intubate and give one of the following: - Midazolam drip IV. Load with 0.2 mg/kg and infuse at rate of 0.03–0.2 mg/kg/hr
Or - Propofol IV. Load 1–2 mg/kg repeat every 5 mins till seizures stop, followed by IV infusion 2–10 mg/hr.
Or - Phenobarbitone IV bolus 6–8 mg/kg at a rate not more than 60 mg/min.
Partial (local) minor status epilepticus consists of frequent seizures involving an extremity or facial muscles with preservation of consciousness and no tendency for generalization. - Phenytoin orally during an 8 to 12 hours period
followed by maintenance dose of 300 to 400 mg/day.
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