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Key Features

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  • Medical emergency

  • Classified as

    • Convulsive (the common tonic-clonic, or grand mal, status epilepticus)

    • Nonconvulsive (characterized by altered mental status or behavior with subtle or absent motor components)

  • Absence status, or spike-wave stupor, and focal status epilepticus are examples of the nonconvulsive type

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Clinical Findings

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  • Usually defined as a clinical or electrical seizure lasting at least 15 minutes, or a series of seizures without complete recovery over a 30-minute period

  • After 30 minutes of seizure activity, hypoxia and acidosis occur, with depletion of energy stores, cerebral edema, and structural damage

  • Eventually, high fever, hypotension, respiratory depression, and even death may occur

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Diagnosis

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  • An EEG may be necessary to aid in diagnosing nonconvulsive status because patients sometimes appear merely stuporous and lack typical convulsive movements

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Treatment

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  • See Table 25–8

  • Aggressive treatment of prolonged seizures may prevent development of status epilepticus

  • Benzodiazepines

    • Generally recommended for outpatient management of prolonged seizures

    • Initiate 5 minutes after onset of a seizure

    • Options that can be administered safely at home include rectal valium, intranasal midazolam, sublingual lorazepam, and intramuscular diazepam

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Table Graphic Jump Location
Table 25-8.Principal dietary restrictions in MAOI use.

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