The Differential Diagnosis of Status Epilepticus From A Core EM Podcast

I was listening to Core Em‘s great brief podcast on hyponatremia (Episode 58 – Hyponatremia) and it began with a case of status epilepticus. There is an excellent brief discussion of the causes of status epilepticus. Here is the case (after the case presentation they briefly and effectively reviewed the causes and treatment of hyponatremia):

This is a 19-year-old girl who was at a concert when she started seizing. EMS says they picked her up at a concert where she was seizing. She’s received three doses of midazolam from EMS. And she got no better. And she is still seizing when she gets to the ER.

So clearly she is in status epilepticus [operationally, any patient who has a seizure that lasts 5 minutes and continues is in status and needs treatment – Episode 73 Emergency Management of Pediatric Seizures from Emergency Medicine Cases]:

So let’s go through a quick differential.

In patients with status you have to think of vital sign abnormalities that could be causing this such as hypoxia, hyperthermia [pediatric febrile seizures], and severe hypertension.

She could be in status because of trauma, intracranial hemorrhage, brain tumor, or intracranial infections.

She could have the status as a result of toxic exposures, electrolyte abnormalities, or hypoglycemia.

If it’s none of those things it may be simply the result of an underlying seizure disorder.

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