Do you give benzo's to a hypoglycemic seizure?

[buddha]

Too many of you are ASSUMING that the patient's seizures are secondary to acute hypoglycemia. Has anyone who's posted here actually ever given glucagon?? It doesn't work instantly. I have given glucagon for acute hypoglycemia and it has taken upwards of 10 minutes to show marked improvement. How many of you would like to watch a patient continue to seize for 10 minutes while you are waiting to see if your theory is correct??

Again - break the seizure with your benzo of choice, open and clear the airway, do a BG, and treat if needed. Simple.

[Ridryder 911]

Very good point Buddha.. I too have never seen Glucagon work in < than 10 minutes.. (I.M.) and if you could give it I.V. why not give D50W ?.. duh.. c'mon treat the patient... hopefully you can treat the cause.. if not treat the adverse effect of hypoglycemia (seizures) . This debate has is ridiculous. Something this simple... even e-med addresses(quotation mine) " treatment of etiology then tx. of seizures; if not able to administer glucose stop seizure activity as soon as possible and then treat hypoglycemia"..

I rarely see hypoglycemic induced seizures; there are more important issues out there. Hopefully, we are making sure that glucose will be introduced ASAP and the seizures are treated ASAP as well...

Be safe,

Ridryder 911

[kevkei]

I rarely see hypoglycemic induced seizures; there are more important issues out there. Hopefully, we are making sure that glucose will be introduced ASAP and the seizures are treated ASAP as well...

Be safe,

Ridryder 911

I agree. Hypoglycemic seizures that I have seen are short lived, not a generalized, status seizure. In addition, giving glucagon to a hypoglycemic patient that is in a true status epilepticus will probably be ineffective. By that point, if they are hypoglycemic secondary to the seizure, they have likely used up any glycogen stores they have. Since glucagon causes glycogenolysis, you would need metabolic replacement through D10,25,50W.

[Ace844]

Hi All,

Just want to thank "Rid, Buddah, Flight, and others," who have taken the time to restate the main point of the discussion here which I think the point trying to be made ends up being....

1.) Never assume anything

2.) Assess, treat life threats, reassess, find underlying causes, treat, assess, reassess, etc.. ad nauseaum...

3.) For those having trouble understanding this please reread the posts, educate yourself, ask questions...

out here,

Ace844

[Ace844]

The data speaks for itself again..!!

Seizures in Hyperglycemia

James C. Kolb, Robert Cox, Loretta Jackson-Williams and Samuel Nicholson

University of Mississippi Medical Center: Jackson, MS, Scott and White Hospital: Temple, TX

ABSTRACT

Background: Seizures are sometimes attributed to hyperglycemia. Objectives: To evaluate the frequency and type of seizure, and glucose (glu) level of patients with hyperglycemia. Methods: This study is part of a study that focused on focal deficits but prospectively asked about seizures in patients with hyperglycemia. This IRB-approved study looked at consecutive patients > 15 years with glu level over 400 mg/dL. Physicians using a computerized chart were required to answer four questions before they could close the chart: "Does the patient have a glucose > 400 mg/dl?", "Does the patient have a focal neurologic deficit?", "Does the patient have a history of prior neurologic deficit?", and "Has the patient had any seizure activity with current episode?" "Focal deficit" was not defined to encourage all deficit inclusion. Level of alertness was determined by a modification of the Ramsey scale. Results: 10 of 813 hyperglycemic episodes had entries for apparent seizure. Of these, one had a questionable seizure the day before, a normal neurologic examination, and presented for axillary abscess, and another had spasms of right thumb that were felt to not be seizure. Only eight of 813 (1%) of patients with glu >400 had a seizure. Six were new-onset and, of these, two had generalized status epilepticus (one had glu 447 and residual brain scar from brain abscess, and the other, glu 539 with no brain abnormality), three had focal seizures (glu of 859, 1,833, 1,013), and one a generalized seizure (glu 1,227). Two had known seizure disorder, one was therapeutic on carbamazepine (glu 450), the other subtherapeutic on phenytoin (glu 564). Two patients had preceding known structural brain abnormality and one had new-onset stroke with seizure. Only three of 44 patients with glucose >1,000 (7%) had a seizure activity. Conclusions: Seizures induced by hyperglycemia are rare even at high levels of glucose but can occur in the absence of other precipitants and can be focal or generalized.

hope this helps...,

Ace844

[fireflymedic]

Our protocols state treat the underlying cause first. However, IF you cannot obtain a line and the patient is actively seizing, I would go for IM or nasal versed or PR valium to stop the seizures, then administer glucagon. Reason being, glucagon can take a bit of time to work as it has to process the glycogen stores in the body. You do not want a patient continuously seizing while you are waiting for the glucagon to take effect. Also, you may run into the problem, especially in alcoholics that they may not have adequate glycogen stored in the body for the glucagon to work effectively. Also, the cessation of seizures may make it easier to obtain an IV and get D-50 in them. Either way, the seizures and the hypoglycemic state have the potential to cause damage, so you would be better off going ahead and giving the benzos while waiting for the glucagon to work, or to establish a line than deciding what to do.

[ffpm41]

I just had a case like this. The patient was a known diabetic with a sugar of 22, was actively seizing, and I couldn't obtain IV access (got the line, couldn't advance the cath). I gave him 2 mg Versed IM, got the IV and gave him the D50, and he came around like a normal diabetic.

As for Glucagon, he had been seizing for 15-20 min and I didn't want to wait or blow out all of his reserve stores until I absolutely needed to, he didn't need it after D50.

[firefighter523]

"GIVE THE GLUCAGON FIRST TRY CORRECT THE UNDERLYING PROBLEM "

You are kidding right? So you are going to wait the 5 to 20 minutes that it will take for the glucagon to MAYBE work. You wont have to worry about the glucagon working, they will already be dead from anoxia!!

Break the siezure first, then treat the underlying prob. If you can't get the IV, then titrate valium up to 5 via nasal atomizer.

[Medic26]

I think that this was a no brainer from the beggining.......STOP the seizure first, then treat low blood sugar when you get to that point. It was really fun to read some of your thoughts though. :oops: