Not all SEIZURES are the same!
We see them all the time in the ED... but here are a few πππ to remember when the patient isn't the classic... "I forgot to pick up my refills" seizure/status epilepticus case
- Josh
1/7
We see them all the time in the ED... but here are a few πππ to remember when the patient isn't the classic... "I forgot to pick up my refills" seizure/status epilepticus case
- Josh
1/7
πΊ Withdrawal Seizure π₯
Patho: β€΅οΈ regulation of synaptic GABAπ °οΈ r.
Tx: BZDs, phenobarbital, propofol (in this order)
β evidence to support use of non-GABAergic π (levetiracetam, CBZ, phenytoin, etc)
π Phenytoin vs placebo RCT = no difference
PMID:[2024792][16372057]
2/7
Patho: β€΅οΈ regulation of synaptic GABAπ °οΈ r.
Tx: BZDs, phenobarbital, propofol (in this order)
β evidence to support use of non-GABAergic π (levetiracetam, CBZ, phenytoin, etc)
π Phenytoin vs placebo RCT = no difference
PMID:[2024792][16372057]
2/7
πΊ Eclamptic Seizure πΌ
Tx: MgSO4 4-6g IV over 15-20min
- if no IV access, 5g IM each buttock (ouch)
π BZD/phenytoin if Mg++ is contraindicated (ex: myasthenia gravis)
π ~80% of eclamptic seizures preceded by severe HA, blurred vision, photophobia, AMS
PMID:[30575675]
3/7
Tx: MgSO4 4-6g IV over 15-20min
- if no IV access, 5g IM each buttock (ouch)
π BZD/phenytoin if Mg++ is contraindicated (ex: myasthenia gravis)
π ~80% of eclamptic seizures preceded by severe HA, blurred vision, photophobia, AMS
PMID:[30575675]
3/7
π¦ Isoniazid-induced Seizure π§«
Patho: INH decreases π§ GABA lvls & causes lactic acidosis
π Pyridoxine (vit. B6) is a co-factor for GABA synthesis
Tx: Pyridoxine 1g IV for each g of INH
π 1g over 1 min; repeat Q 5-10 min until seizure π [Max = 5g]
PMID:[29397257]
4/7
Patho: INH decreases π§ GABA lvls & causes lactic acidosis
π Pyridoxine (vit. B6) is a co-factor for GABA synthesis
Tx: Pyridoxine 1g IV for each g of INH
π 1g over 1 min; repeat Q 5-10 min until seizure π [Max = 5g]
PMID:[29397257]
4/7
π§Hyponatremia-induced Seizureπ§
Etiology: Multifactorial, risk β¬οΈ when serum Na+ < 120 mEq/L
π π for diuretics, SSRIs, CBZ, DDVAP
Tx: Hypertonic saline (3%)
π Target β¬οΈ 6-8 but < 12mEq/L in 24 hr & < 18mEq/L in 48 hr
π Faster repletion can cause ODS
PMID:[25822386]
5/7
Etiology: Multifactorial, risk β¬οΈ when serum Na+ < 120 mEq/L
π π for diuretics, SSRIs, CBZ, DDVAP
Tx: Hypertonic saline (3%)
π Target β¬οΈ 6-8 but < 12mEq/L in 24 hr & < 18mEq/L in 48 hr
π Faster repletion can cause ODS
PMID:[25822386]
5/7
Hypoglycemia & Seizures
Tx: Fix BG β‘οΈ 50-100mL D50%W, glucagon
"Kitchen Sink" for refractory cases
π IV hydrocortisone β‘οΈ induce peripheral insulin resistance
π Octreotide 50-100mcg Q6H if sulfonylurea overdose
π Supplemental K+ in insulin/SU overdose
PMID:[29316226]
6/7
Tx: Fix BG β‘οΈ 50-100mL D50%W, glucagon
"Kitchen Sink" for refractory cases
π IV hydrocortisone β‘οΈ induce peripheral insulin resistance
π Octreotide 50-100mcg Q6H if sulfonylurea overdose
π Supplemental K+ in insulin/SU overdose
PMID:[29316226]
6/7
Bottom Line:
β A good hx & peak into the pt's med-profile may help u identify a precipitating drug/etiology of the seizure
β Not all seizures are the same
β‘οΈWhat interesting cases have u encountered in practiceβ Please shareβ
#TwitteRx #MedTwitter #emergencymedicine
β A good hx & peak into the pt's med-profile may help u identify a precipitating drug/etiology of the seizure
β Not all seizures are the same
β‘οΈWhat interesting cases have u encountered in practiceβ Please shareβ
#TwitteRx #MedTwitter #emergencymedicine
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