1. Status Epilepticus And Hypoglycaemia

2. Fits History and Examination Differential diagnosis –alcohol/drugs (and withdrawal thereof) –infection –tumour –trauma, dysrhythmias, thromboembolic phenomena

3. Status Epilepticus Continuous or recurrent seizures for >30 minutes Complications: hyper pyrexia, hypotension, hypoxia, tachycardia. Prolonged seizures: hypoglycaemia, pulmonary oedema, raised ICP.

4. Management ABC Investigations: BM, Ca & Mg Monitoring: saturations, pulse, BP, temperature Treatment

5. Adaptations for palliative care patients Drugs: –Diazepam 10mg pr, repeat after 15 and 30 minutes –Midazolam 10mg sc/iv repeat after 15-20 minutes or intranasal (10-20 mg) –2nd line: Phenobarbital 100mg sc (diluted) or 100mg in 100ml saline iv over 30 min

6. Hypoglycaemia BM <3 Causes: –drugs, hypoadrenalism, hypopituitarism, liver failure, anti-insulin antibodies –Insulinoma –Other tumours: large, intrathoracic or retroperitoneal +/- liver involvement

7. Clinical features Usually terminal stages Agitation, stupor, coma, seizures Early morning/late afternoon Focal neurological deficit

8. Treatment ABC Oral glucose or 50ml of 50% dextrose iv Glucagon 1mg