Epilepsy - Status epilepticus
- Treatment

Treatment should be initiated as soon as possible in all patients with continuous seizure activity lasting more than 10 minutes.

General principle

Seizure control within 30 minutes of presentation.

 

Immediate treatment

Large bore IV line inserted

Start:

• Oxygen
• Cardiac monitor
• Pulse oxymeter
• Nasogastric tube
• If hypoglycemia is suspected or confirmed
     -> IV thiamine and glucose

 

Drug treatment

Benzodiazepine (diazepam OR clonazepam OR midazolam)

          Followed by

Phenytoin OR fosphenytoin

 

Diazepam

Fast onset

Level falls rapidly due to fatty tissue redistribution

 

Phenytoin

Most important drug treatment

• THE drug that will stop status epilepticus
• slow onset

Must not be given with glucose-containing IV fluid.

Must be infused at a slow rate (<50mg/min).

Contraindicated in 2nd degree or 3rd degree heart block, or during a MI or CHF.