Pediatric Seizure and Status Epilepticus Management in the Emergency Setting Edward P. Sloan, MD, MPH Associate Professor Department of Emergency Medicine University of Illinois Chicago, IL. Case.
Pediatric Seizure and Status Epilepticus Management in the Emergency SettingEdward P. Sloan, MD, MPHAssociate ProfessorDepartment of Emergency MedicineUniversity of IllinoisChicago, IL
A 7-year old boy presents to the ED with a history of staring spells, some shaking movements, and headache over the past day. He has no history of seizures or epilepsy. In the ED, he has three episodes of tachycardia, staring and confusion that last several minutes and resolve without therapy. He then has a similar episode associated with diaphoresis and urinary incontinence. His most likely diagnosis is:
old represent repeated seizures, all of the
following are acceptable initial therapies except:
A 13-year old female presents at mid-morning to the ED with a one-day history of a frontal headache, consistent with prior migraines, that was relieved with ibuprofen. She also was noted by family members to be restless in bed, and was noted to “thrash about for a brief period of time.” The family denied that this was a generalized seizure, and denied any history of epilepsy, trauma, drug ingestion, or similar episodes. The patient has a similar episode in the ED, and then has a generalized seizure.
A 21-year old male college student presents in the early morning to the ED with a one-day history of having a generalized seizure upon awakening. The patient had been partying after final exams, and had not been getting much sleep for several days. Over the phone, his mom noted that he had a history of “staring spells” as a child.
The above 21-year old patient had two seizures in the ED which were controlled with lorazepam. If a load of a longer acting AED was to be given in the ED in order to prevent status epilepticus, what would be the optimal drug to administer?
If an IV valproate load of 25 mg/kg were given to this patient, what would be the expected valproate level once the infusion had ended?
If this patient were to develop status epilepticus, what is the fastest time of infusion possible for a loading valproate infusion of 2500 mg (25 mg/kg x 100 kg)?
Fastest Infusion Time Possible?