Read on Twitter
Not all SEIZURES are the same!
We see them all the time in the ED... but here are a few
to remember when the patient isn't the classic... "I forgot to pick up my refills" seizure/status epilepticus case
- Josh
1/7
We see them all the time in the ED... but here are a few
to remember when the patient isn't the classic... "I forgot to pick up my refills" seizure/status epilepticus case - Josh
1/7
Withdrawal Seizure 
Patho:
regulation of synaptic GABA
r.Tx: BZDs, phenobarbital, propofol (in this order)
evidence to support use of non-GABAergic 
(levetiracetam, CBZ, phenytoin, etc) Phenytoin vs placebo RCT = no differencePMID:[2024792][16372057]
2/7
Eclamptic Seizure 
Tx: MgSO4 4-6g IV over 15-20min
- if no IV access, 5g IM each buttock (ouch)
BZD/phenytoin if Mg++ is contraindicated (ex: myasthenia gravis) ~80% of eclamptic seizures preceded by severe HA, blurred vision, photophobia, AMSPMID:[30575675]
3/7
Isoniazid-induced Seizure 
Patho: INH decreases
GABA lvls & causes lactic acidosis Pyridoxine (vit. B6) is a co-factor for GABA synthesis Tx: Pyridoxine 1g IV for each g of INH
1g over 1 min; repeat Q 5-10 min until seizure 
[Max = 5g]PMID:[29397257]
4/7
Hyponatremia-induced SeizureEtiology: Multifactorial, risk
when serum Na+ < 120 mEq/L 
for diuretics, SSRIs, CBZ, DDVAPTx: Hypertonic saline (3%)
Target 6-8 but < 12mEq/L in 24 hr & < 18mEq/L in 48 hr Faster repletion can cause ODSPMID:[25822386]
5/7
Hypoglycemia & Seizures
Tx: Fix BG
50-100mL D50%W, glucagon
"Kitchen Sink" for refractory cases
IV hydrocortisone induce peripheral insulin resistance
Octreotide 50-100mcg Q6H if sulfonylurea overdose
Supplemental K+ in insulin/SU overdose
PMID:[29316226]
6/7
Tx: Fix BG
50-100mL D50%W, glucagon"Kitchen Sink" for refractory cases
IV hydrocortisone induce peripheral insulin resistance Octreotide 50-100mcg Q6H if sulfonylurea overdose Supplemental K+ in insulin/SU overdosePMID:[29316226]
6/7
Bottom Line:
A good hx & peak into the pt's med-profile may help u identify a precipitating drug/etiology of the seizure
Not all seizures are the same
What interesting cases have u encountered in practice
Please share
#TwitteRx #MedTwitter #emergencymedicine
A good hx & peak into the pt's med-profile may help u identify a precipitating drug/etiology of the seizure Not all seizures are the sameWhat interesting cases have u encountered in practice Please share#TwitteRx #MedTwitter #emergencymedicine
