بسم الله الرحمن الرحيم. Seizure due to Electrolytes Disturbances. Dr. Nasser Haidar MRCP (UK), ABM, KSUF, PCCMF, FRCPCH. Life Long Learning. Introduction. Body fluid and Electrolytes distrib . Electrolytes functions. General outlines in electrloytes disturb. Na. Ca. Mg. Summary.
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Seizure due to Electrolytes Disturbances
Dr. Nasser Haidar
MRCP (UK), ABM, KSUF, PCCMF, FRCPCH
Life Long Learning
Body fluid and Electrolytes distrib.
General outlines in electrloytes disturb.
60% of Body Weight Water
Na+ 142 K+ 5
Ca+ 5 Mg++ 2
Ph – 149
Cl 105 HCO3 24
Prot. 16 Phos 2
Sulfate 1 Total 154
Na and Cl
Routine lab. findings
Na, Ca and Mg
Acute and/or severe
Prevent permanent brain damage
Regulation of ionic balance
Ion gradients across cell memb.
Disturbed Homeostatic brain systems
Consequences on brain metabolism and function
Seizure Structural (Irreversible)
Na and osmolality
Neuronal depression, with encephalopathy
other seizure occur.
Not possible to assign absolute levels
375 adult cases of status epil.(SE),
10% had a metabolic disorder as the primary etiology of their seizure
With first-time seizures
Anticipate in certain conditions
Treatment of the underlying cause
Anticonvulsant not necessary
Mixtures of epileptiformdischarges, high incidence of triphasic waves (TWs), and (as a rule)
reversibility after treatment of underlying causes
The cause of seizures in 70% of infants who lacked findings suggesting another cause
Might Be overcomed.
If hyponat. continued
Hypoxia and ischemia
impair the brain adaptive mechanisms
Concurrent insults [e.g., alcoholism or severe liver dysfunction ].
Induction of excessive water re-absorption in the collecting tubule
< 120 mEq/L usually around 110 mEq/L
Severe or rapid (within hours).
Stopped by rapid increases in Na only 3 to 7 mEq/L
Quick decr. ICP
5 to 6 mmol/L.
Enough to stop sz
Maximum 5- 6 mL/kg of 3% saline bolus
with hypertonic saline may be unnecessary
1 to 2 mmol/L/h
120 - 125 mEq/L.
Rapid Correction of serum Na
Osmolytes goes back slowly into cells
Fluid loss from the neurons and glia
Osmotic Demyelination S. with pontine and extrapontinedemyelination
quadriplegia, pseudobul. palsy, seizures,
Demyelinating lesions may occur despite a careful correction of hyponatremia
Additional risks to demyelination
Hypokalemia, hypophosphatemia, hypoxemia, and
malnutrition with vitamin B defic.
High Na intake
Accidental salt intake
Loss of water from brain cells
Intracellular accumulation of organic osmoly.
Moving electrolytes into cells.
Shrinkage of the brain
Few hours (rapid adap/)
(Slow adapta.) several days
Slowly increasing, to 170mEq/L, well tolerated.
Acute (within hours) elevation to >158–160 mEq/L
Rupture of cerebral veins, focal intracerebral and SAH
Values >180 mEq/L high MR,
Rapid correction may lead to convulsions, coma, and death
Goal - replenish body water
Speed of correction depends on the speed of development
Developed over hours.
PO or NGT or IV
Normal saline in case of frank circulatory compromise, as volume expansion.
Thus overly aggressive therapy carries the risk of serious neurologic impairment in chronic hypernatremia
Ionized <4.0 mg/dl.
Vita. D deff.
Postop, DiGeorg, idiopathic
Acute pancreatitis, citrated blood transf.
the sole presenting symptom
Nonconvulsive SE reported
Seizures may occur without tetany
100 - 300 mg of elemental calcium over 10 to 20 min
Calcium-infusion started at 0.5 mg/kg/h for several hours,
AEDs may abolish tetany, whereas hypocalcemic seizures may remain refractory
Ectopic PTH excr.
Excess action of Vit. D
Thyrotoxicosis, Addison disease,
Chronic severe hypercalcemia
only minimal neurologic symptoms
A rapid increase to
12–13.9 mg/dl marked neurologic dysfunction
Lethargy, confusion, seizure, coma
Chronic or asymptomatic
Treatment of the underlying dis.
Acute or symptomatic
Consider IV bisphosphonates:
Second line: glucocorticoids,
By inhibition of N-methyl-d-aspartate (NMDA) glutamate receptors and the increased production of vasodilator prostaglandins in the brain
Hungry bone syndrome
at levels <1 mEq/L
Seizures or severe
(<1.2 mg/dl, <1 mEq/L)
500 mg/d. PO
IV MgS over a 5-min ,
infusion few hours.
If seizures persist, the bolus may be repeated
Low K & Ca can't be alleviated until magnesium is replaced
Rarely causes symptoms in the CNS, seizures do not occur.
Seizures is important manifestation of electrolyte distur.
More in patients with Na, hypocal., and hypomag.
AEDs alone are generally ineffective
Electrolytes, should be part of the initial workup of sz.
Establishment of early and accurate diagnosis
Rapid and appropriate therapy