Technical procedure for the treatment of convulsions in poisoning

The article is written by Master, Doctor Le Thai Bao - ICU Doctor - Intensive Care Department - Vinmec Times City International Hospital

The convulsions in poisoning occur thicker and stronger with increasing intensity, leading to status epilepticus, also known as continuous convulsions, which will lead to rapid death if not treated promptly. Therefore, convulsion is an emergency and the patient must be stopped immediately to avoid death.

Convulsions in poisoning are usually generalized convulsions, the convulsions occur thicker and stronger with increasing intensity, leading to epileptic state, also known as continuous convulsions, which will lead to rapid death. quickly if not treated promptly. Therefore, convulsion is an emergency and the patient must be stopped immediately to avoid death.
Must exclude life-threatening causes, need to be diagnosed and treated immediately such as CNS infections, hypoglycemia, hyponatremia, hypocalcemia,...
Indications: Patients with convulsions Convulsions due to convulsive substance intoxication, cerebral edema, or high fever in children.
Contraindications : No absolute contraindications

Person performing the procedure
Doctor: Assessing the patient, giving orders, setting monitoring goals and monitoring together during the treatment The nurse administers the medication and monitors the patient. Means
Diazepam injection preparation, Midazolam Phenobarbital (Luminal intravenous tube, intramuscular injection) General anesthetics: Thiopental, Propofol Cura muscle relaxant Pyridoxine (vitamin B6) for patients with convulsions due to INH drug poisoning Antipois or Activated Carbon Sorbitol Glucose or other specific antidotes depending on the cause of the convulsions. Infusion machine, electric syringe pump Ambu ball, mask, oxygen, endotracheal tube, ventilator. Infusion: Glucose 5%, glucose 10% or glucose 20%, sodium chloride 0.9% Sterile infusion kit Patient
Patient often has varying degrees of consciousness disorder Explain the condition to the family. Medical records: Record and comment on the patient's condition in the medical record, indications and methods of treatment of continuous convulsions. Fully exploit and record in medical records, medical history, accompanying diseases.

Adults:
Seduxen 1 ampoule of 10 mg IV slowly, repeat every 5 - 10 minutes until seizure stops, then change the maintenance dose. If seduxen is not available, midazolam can be replaced with 1 ampoule of 5 mg IV slowly and repeat for until seizure stops, switch to maintenance dose. Or Phenobarbital (Luminal IV tube 200mg): Inject slowly IV, repeat until seizure stops, then change maintenance dose Or Thiopental 1g vial mixed with distilled water to 10ml, take into a 2ml (200mg) syringe, inject an estimated dose of 4 mg/kg slowly intravenously, repeat until the seizure stops, then switch to the maintenance dose. Children:
Seduxen ampoule 10mg slowly inject 1/3 of an ampoule, if the convulsions have not stopped, then inject another 1/3 of the tube, repeat until the convulsions stop, then switch to maintenance. Midazolam can be replaced with 5mg intravenous injection slowly (not less than 1 minute) and repeated until the seizure stops, then change the maintenance dose of Phenobarbital (Luminal IV tube 200mg): Dilute into 10ml injection at a rate of 1ml/min. until convulsions stop, change the maintenance dose. Or - Thiopental 1g vial mixed with distilled water to 10ml, take 2ml (200mg) and mix into 10ml slowly inject 1ml/min until convulsions stop, then change the maintenance dose In case a 6-year-old child takes all 5g in 6 hours to control the seizure), then switch to midazolam and propofol to maintain it. due to drugs.

Intubation, mechanical ventilation if the patient is in respiratory failure comatose or intends to maintain anesthesia with anticonvulsant by infusion.

The dose is adjusted according to the patient's response, gradually reducing the dose before stopping completely.
Adults
Seduxen: 10mg tube, tube or IV Gardenal: 0.1g tablet: Adults: 2-4 tablets/day highest dose Thiopental IV infusion adjust dose according to response but not more than 2 mg/kg /hour. Children
Midazolam starting dose 0.15 mg/kg adjusted for response Or propofol 7.5-18 mg/kg/hour IV infusion adjusted according to response Or phenobarbital IV 1-6 mg/kg/day dose Adjust according to response Or gardenal 0.01g tablet: 3 - 10 tablets/day (adjust dose according to patient's clinical response)

Muscle relaxants should only be used when above the maximum dose of drugs that do not control the seizure.

Glucose: It is necessary to exclude the possibility of hypoglycemia in patients with seizures (quick test of capillary blood sugar by test strips), add vitamin B1 when giving glucose. Patients with convulsions caused by INH, hydrazine... should be given intravenous vitamin B6 along with benzodiazepines. Other antidotes: Depending on the cause of the seizure.

Install a monitor to monitor electrocardiogram and blood oxygen saturation (SpO2) until the condition improves. Closely monitor blood pressure. translate every 3 hours

Timely detection of possible complications such as
Pulmonary choking: endoscopic cleaning of the lungs, aspiration of sputum, antibiotics, anti-inflammatory, mechanical ventilation. Hypoglycemia: Sugar infusion, diet Intravenous nutrition Hyperthermia: Lowering body temperature by mechanical means, antipyretic drugs Metabolic acidosis: Increase diuresis, dialysis, find and treat the cause Treat Prophylaxis of acute renal failure due to rhabdomyolysis (always accompanied by convulsions)
Diagnosis: CK > 1000 IU/l, urine red, blood urea increased, blood creatinine increased. Infusion (with oral) to total fluid intake to reach 100-120 mL/kg/24 hours Active diuresis, ensure urine > 90-100 mL/kg/24 hours along with intravenous fluids, give furosemide 20 mg ampoules if little urine or anuria even though not dehydrated and 1 liter of fluid have been transfused Extrarenal dialysis if indicated Visit a medical facility, the doctor will examine and indicate the most useful treatment for you.
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