Rhabdomyolysis
 This week’s case presentation focuses on Rhabdomyolysis – history, examination and investigations. We discuss specific life-threatening complications to watch out for and the ongoing monitoring required for signs of […]
Status Epilepticus
Blog written by Dr Ashly Liu
Definition
A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes is called status epilepticus.Â
Approach to Management
| Timing of Seizure | Management |
| 0 – 5 min – Seizure | Usually self-limiting |
| 5 – 20 min – Status epilepticus | Benzodiazepines (ideally IV)
|
| >20min – Refractory status epilepticus | Anti-epileptics – loading dose
|
| If refractory, consider termination of seizure via Rapid Sequence Induction (RSI) | |
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Pharmacotherapy Options
Benzodiazepines (as per eTG)
- Clonazepam 1mg IV over 2-5 minutes. Repeat once 15 min later if ongoing status epilepticus
- Diazepam 10-20mg IV over 2-5 minutes. Repeat once 15 min later if ongoing status epilepticus
- Midazolam 5-10mg bolus IM, IV or buccally or intranasally
- For IV, start 5mg bolus and onset 30s, then 2.5mg at 2-3min intervals. Once it hits 10-15mg, start considering other agents
- For paediatric patients, 0.15mg/kg bolus
If the seizure continues for 10min despite benzodiazepines, further anticonvulsant loading is required.
Anti-epileptics
The following anti-epileptics have shown to be equally efficacious by the ESTT trial
- Phenytoin – 20mg/kg
- Has increased associated risk of bradyarrhythmia and hypotension
- Sodium valproate – 20mg/kg (max 3000mg)
- Risks: avoid in pregnancy
- Levetiracetam – 60mg/kg (max 4500 mg)
- Preferred in pregnancy
If refractory, RSI and propofol as the last line to terminate the seizure
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Sources: https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/neurology/seizures/seizure-medications
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