Status Epilepticus

General measures:

Oxygen

Establish IV access in large veins

Take blood for electrolytes, glucose, calcium & anti-epileptic drug levels.

Specific drug therapy:-

Inj Lorazepam 2-4 mg or

Inj Midazolam 4-10 mg or

Inj Leviteracitam 500 - 1000 mg or

Inj Diazepam 5 -10 mg IV , repeat if necessary.

Step 2:

10 minutes. If seizures continue Phenytoin 15-18 mg/kg diluted to 10mg/ml in normal saline @50mg/min.

alternative step 2 : in patient receiving adequate phenytoin:

# Inj Phenobarbitone10mg/kg diluted 1:10 in water for injection at 100mg/min. Monitor BP and respiration.

# Inj Valproate 20-30 mg/Kg IV over 5-10 min

Step 3: If severe systemic disturbances occur at any stages or if seizures continue:

# Anaesthesia with IV thiopentone and ventilation with EEG monitoring until seizures ceases. Note: - Propofol can be used IV alternatively. Dose: 1-3 mg/Kg bolus over 5 minutes followed by maintenance infusion of 2-4 mm/Hg/hr.

For emergency seizure control Status epilepticus and emergency seizures (home to hospital)

# Midazolam nasal spray (5-10 puffs per nostril)