SEIZURES-ACUTE MANAGEMENT

SUMMARY

1. Intravenous benzodiazepines (diazepam, lorazepam, midazolam) are the drugs of choice.

2. Phenytoin also is effective, but it takes longer to infuse.

3. Alcohol withdrawal seizures are customarily treated acutely with IV benzodiazepines or phenytoin.

4. Typical treatment of status epilepticus in the adult: Give thiamine and then D₅₀ 50 mL if low BSL, then benzodiazepine (lorazepam preferred x 2 doses) followed by a loading dose of phenytoin or equivalent fosphenytoin.

5. If the patient is still seizing, give a 3'd dose of lorazepam, maximize the phenytoin dose, and then proceed to a barbiturate (phenobarbital or pentobarbital).

6. Transfer to ICU settings if seizures are not controlled by the first 2 doses of lorazepam and a dose of phenytoin.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].