Status epilepticus

Monitoring: The following parameters should be monitored (endpoint values are provided where available):

1. Airway and breathing:
   • Provide oxygen supplementation
   • Respiratory rate: 10–25 breaths/min
   • SpO2: >95%
   • PaO2: >80mmHg, PaCO2: <35–40 mmHg.
2. Circulation:
   • Assess for tachycardia, bradycardia and arrhythmias. Can occur for up to 72 hours
   • Mean arterial blood pressure: 80–120 mmHg.
3. Temperature: 37–38.5°C.
4. If signs of increased intracranial pressure are present, consider mannitol after initial stabilization (see ‘Raised intracranial pressure’, below).
5. Glucose:
   • 4–6 mmol/l
   • Treat hypoglycaemia if glucose <3.3 mmol/l
   • 0.5–1 ml/kg of 50% dextrose diluted to 10% solution given slowly i.v.
6. Other blood tests: CBC, electrolytes (Ca, K, Na, Cl), biochemistry ± ammonia ± bile acids ± toxicology profile.
7. Other tests: magnetic resonance imaging/computed tomography ± CSF tap.

Raised intracranial pressure

Mannitol: 0.25–1 g/kg i.v. infusion of 15–20% solution over 30 min. May repeat 1–2 times after 4–8 hours as long as hydration and electrolytes monitored.