Status Epilepticus
Clinical Features
A succession of seizures without regaining consciousness between attacks or one prolonged convulsion lasting 30 minutes or more. Status epilepticus can occur with partial, complex partial, absence, tonic-clonic, or clonic seizures and may result in respiratory embarrassment with cyanosis and hypoglycemia.
Management
The following is recommended in stabilizing child with status epilepticus
For the airway and breathing:
Establish the airway.
Give oxygen
Provide ventilation
With regard to circulation and disability
Establish intravenous access.
Give 10% dextrose 5 ml/kg.
Give diazepam intravenously or rectally.
Management-Pharmacological
In the first 5-15 minutes:
Give diazepam: 0.2-0.5mg/kg IV over 1-3 minutes or 0.5mg.kg rectally (max 10mg in 1-3 years and 15mg in 3-15 years). Repeat after 5-10 minutes if not controlled.
In the next 15-45 minutes:
If seizure persist: Use phenobarbitine or phenytoin
-Phenobarbitone: Loading dose 15-20 mg/kg IV in 5 minutes.
-Rate of infusion does not exceed 1 mg/kg/min.
-Additional 5mg/kg/dose can be repeated every 15-30 minutes to a max of 30 mg/kg.
-IV Phenytoin (with glucose-free solution). Loading dose 15-20 mg/kg. Infusion not to exceed 1 mg/kg/minute.
In the next 45-60 minutes:
If all these do not control the convulsion, or severe respiratory depression results from the drugs, the child needs ICU care where ventilation can be done.
When the patient is stable, look for the cause and treat as needed.