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PATIENT PRESENTATION

Chief Complaint

“I have terrible stomachache. I keep vomiting and needing to go to the bathroom over and over”

History of Present Illness

Arnold Smith is a 50-year-old man who is admitted to the hospital with gastrointestinal distress. He states that he has had severe diarrhea, vomiting, and stomach pains for the last 2 days, to the point that he has not been able to eat or drink very much or take any of his medications. As the nurse is putting in an IV line, he starts to shake uncontrollably for three minutes after which he is unresponsive.

Status epilepticus is a medical emergency and should be assessed and treated immediately. Parenteral benzodiazepines are considered emergent therapy for status epilepticus and need to be administered at the recommended doses to be most effective. Urgent therapy with parenteral anticonvulsants should then be initiated to prevent recurrent seizure activity. Electroencephalography is required to guide treatment of refractory status epilepticus and to identify patients in nonconvulsive status epilepticus.

Student Work-Up

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Missing Information?

Evaluate:

Patient Database

Drug Therapy Problems

Care Plan (by Problem)

TARGETED QUESTIONS

  1. What signs of status epilepticus does this patient have?

    Hint: See Clinical Presentation and Diagnosis in PPP

  2. What are the most likely causes of status epilepticus in this patient?

    Hint: See Pathophysiology in PPP

  3. What medication(s) would you recommend to halt status epilepticus in this patient?

    Hint: See Treatment and Tables 33-1 and 33-2 in PPP

  4. What medication(s) would you recommend to prevent recurrent seizure activity in this patient?

    Hint: See Treatment and Tables 33-1 and 33-2 in PPP

  5. What drug recommendations would you give for emergent and urgent therapy if intravenous access was not available in this patient?

    Hint: See Treatment and Tables 33-1 and 33-2 in PPP

FOLLOW-UP

What further tests or interventions can be recommended at this time?

Hint: See Outcome Evaluation in PPP

CASE SUMMARY

Global Perspective

The incidence of seizures is greater in developing countries compared to the United States, and a large proportion of patients receive no treatment due to social taboos and lack of access to medications. Given the higher incidence of seizure disorders and lack of access to therapy in many patients, it is likely there is a higher incidence of status epilepticus in developing countries. Although the overall therapeutic approach would be the same, patients in developing countries may have limited resources for emergency medical care. While first-line medications, such as benzodiazepines, phenytoin, and valproic acid may be available, newer intravenous medications may not be available to treat refractory ...

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