Which one of the following drugs is used to treat status epilepticus?
Correct Answer: Diazepam
Description: Status epilepticus In status epilepticus seizure activity occurs for >30 min, or two or more seizures occur without recovery of consciousness. Recurrent tonic-clonic convulsions without recovery of consciousness in between is an emergency; fits have to be controlled as quickly as possible to prevent death and permanent brain damage. (a) Diazepam 10 mg i.v. bolus injection (2 mg/ min) followed by fractional doses every 10 min or slow infusion titrated to control the fits has been the standard treatment. However, it redistributes rapidly so that anticonvulsant effect stas fading after 20 min. Lorazepam is less lipid soluble with slow redistribution: anticonvulsant effect of i.v. dose lasts for 6-12 hours. It is therefore preferred; 0.1 mg/kg (injected at 2 mg/ min) is effective in 75-90% cases. (b) Phenobarbitone (100-200 mg i.m./i.v.) or phenytoin (25-50 mg/min in a running saline i.v. line; not to be mixed with glucose solution because it precipitates. Fosphenytoin is used in its place now; maximum 1000 mg phenytoin equivalent). These drugs act more slowly; may be used alternatively to diazepam/lorazepam or substituted for them after the convulsions have been controlled. (c) Refractory cases may be treated with i.v. midazolam/ propofol/ thiopentone anaesthesia, with or without curarization. (d) General measures, including maintenance of airway (intubation if required), oxygenation, fluid and electrolyte balance, BP, normal cardiac rhythm, euglycaemia and care of the unconscious must be taken. Ref K D Tripathi 8th edition
Category:
Pharmacology
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