Define status epilepticus:
Consider etiologies:
Remember ABCs and supportive care in addition to treating seizures
Learn dosing for hypoglycemic seizure with dextrose
Learn dosing for hyponatremia seizure with 3% NaCl
Medications
First line:
Second line:
Refractory/Third line:
- >5 min seizure- impending status epilepticus
- >30 min- established SE
- >60 min- refractory SE
Consider etiologies:
- Trauma/bleed
- AVM Malformation
- Febrile seizures
- Infection
- Tumor
- Subtherapeutic meds
- Lowered threshold with infection
- Stroke
- Cardiac/arrhythmia
- Hypertensive Crisis
- Pyridoxine deficiency/INH overdose
- NMDA receptor Ab
- FIRES
Remember ABCs and supportive care in addition to treating seizures
Learn dosing for hypoglycemic seizure with dextrose
- Rule of 50's
Learn dosing for hyponatremia seizure with 3% NaCl
Medications
First line:
- Midazolam 0.15 mg/kg IV, 0.3 mg/kg buccal
- Lorazepam 0.05-0.1 mg/kg IV, max 4 mg/dose rpt x 1
- Diazepam 0.05-0.3 mg/kg IV, 0.5 mg/kg PR, max 5 mg
Second line:
- Fospheny load 15-20 mg/kg IV
- Levetiracetam load 15-20 mg/kg IV
- Valproate load 20-40 mg/kg IV
Refractory/Third line:
- Phenobarb load 20 mg/kg IV, 1 mg/kg/min
- Pentobarb 5 mg/kg load
- Propofol 2.5-3.5 mg/kg IV, rate 0.1-0.3 mg/kg/min
- Ketamine 0.5-2 mg/kg IV, rate 5-20 mcg/kg/min
- Pyridoxine 70 mg/kg max 5g, repeat as needed