Pitfalls

  • The majority of seizures will be self-limiting and will cease spontaneously within five minutes. Seizures persisting beyond five minutes should be treated as SE
  • Failure to treat patients with convulsions on the basis that they may actually represent pseudo-seizures. It represents a far greater danger to fail to treat a patient who may have genuine SE than it does to assume the seizure is functional rather than organic
  • Leaving too short a time for an agent to have its effect before instituting treatment with a further agent. This may compound any adverse effects. For patients with impending SE, 10 minutes should be allowed between subsequent drug doses
  • Prescribing intravenous sodium bicarbonate for patients in SE with a profound metabolic acidosis. This acidosis will usually resolve spontaneously and may contribute to the cessation of convulsions.
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