Seizure lasting ≥5 minutes or recurrent seizures without recovery of consciousness between them.
Investigations
- • Capillary glucose immediately
- • U&E, calcium, magnesium, FBC, LFT, antiseizure drug levels
- • Toxicology, β-hCG
- • CT head then LP if indicated
- • EEG if no wake-up at 20–30 min (non-convulsive status)
Management
- • 0–5 min: ABC, O₂, glucose, IV access
- • 5–20 min: lorazepam 4 mg IV (or midazolam 10 mg IM/buccal), repeat once
- • 20–40 min: levetiracetam 60 mg/kg (max 4.5 g) or valproate 40 mg/kg or phenytoin 20 mg/kg
- • 40+ min: intubate and infuse propofol/midazolam/thiopentone with EEG monitoring
Complications
- • Aspiration
- • Rhabdomyolysis, AKI
- • Neuronal injury
- • Cardiorespiratory arrest
Clinical pearls
- • Give thiamine before glucose in alcohol dependence
- • Check pregnancy — eclampsia needs magnesium, not standard antiseizure drugs
Related in WardRound
Educational — verify locally.
