EPILEPSY MANAGEMENT-AUSTRALIA

Treatment of status epilepticus in hospital.


1.Immediate measures Secure airway

Give oxygen
Assess cardiac and respiratory function
Secure iv access
Give lorazepam 4 mg iv or diazepam
10 mg iv
Repeat after 10 mins if no response

2.In hospital


Take blood for electrolytes, LFT, calcium,
glucose, clotting, AED levels and storage
for later analysis
Measure blood gases
Establish aetiology
Give thiamine or 50% glucose solution if
indicated
Within 30 minutes In patients with established epilepsy:
give usual AED orally, NG or iv

3.In patients with new-onset epilepsy or if
seizures continue:

fosphenytoin (18 mg/kg phenytoin
equivalent), up to 150 mg/min with ECG
monitoring or phenytoin 18mg/kg,
50 mg/min with ECG or phenobarbital
15 mg/kg iv, 100 mg/min
Longer than ITU may be necessary
minutes Anaesthetise with EEG monitoring
Midazolam, phenobarbital, propofol, or
thiopentone most commonly used
Non-convulsive status Augment or reinstate usual AEDs
Consider lorazepam or diazepam iv