Status epilepticus (peds)
Background
For a child over 1 month of age
- Defined as: an unresponsive patient with either one of the following
- Seizure >5 min and/or ongoing seizure on presentation
- 2 or more seizures without full recovery of consciousness between seizures
- Categorized as convulsive or non-convulsive
- Convulsive status epilepticus: patient will have tonic-clonic movements with altered mental status, may have focal neuro deficits post-ictally (Todd's paralysis)
- Non-convulsive status epilepticus: patient will have seizure activity on EEG without clinical findings
Clinical Features
Differential Diagnosis
Evaluation
Workup
- Check a blood glucose
- Consider an electrolyte panel, a blood gas, CBC, calcium level, LFTs
- If appropriate collect anticonvulsant drug levels
- Consider blood & urine culture
- Data for lumbar puncture routinely is not conclusive - consider it in a febrile patient with signs of meningitis or localized neuro findings (perform once patient is stabilized)
- Consider toxicology studies
- Consider EKG to evaluate for arrhythmias, toxins and electrolyte abnormalities
Diagnosis
Management
- ABC's
- Provide O2 via non-rebreather mask, 10-15 L/min
- Give benzodiazepines as early as possible
- Monitor for respiratory depression
- Give acetaminophen 15 mg/kg/dose (MAX 650 mg) if febrile