Page 27 - Learnwell EVS
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1. A few symptomes and syndromes
sodium valproate P O
C h ild ren o ver 2 0 k g: initial d o se o f 4 0 0 m g in 2 d ivid ed d o ses irresp ective o f
weight; if ne1cessary , increase the do se p ro gressively until the o p tim al d o se fo r
the
ind ivid ual has been reached (usually 2 0 to 3 0 m g/ k g/ d ay in 2 d ivid ed d o ses).
A d ults: initial d o se o f 6 0 0 m g/ d ay in 2 d ivid ed d o ses; increase by 2 0 0 m g/ d ay
every 3 d ay s until the o p tim al d o se fo r the ind ivid ual has been reached (usually
1 to 2 g/ d ay in 2 d ivid ed d o ses).
phenobarbital P O
C hild ren: initial d o se o f 3 to 4 m g/ k g/ d ay at night, increase the d o se p ro gressively
to 8 m g/ k g/ d ay if necessary
A d ults: initial d o se o f 2 m g/ k g/ d ay at night (witho ut exceed ing 1 0 0 m g p er d ay ),
increase the d o se p ro gressively to 6 m g/ k g/ d ay if necessary
Special situation: seizures during pregnancy
– Eclampsia: seiz ures d uring the third trim ester o f p regnancy , m o st co m m o nly in the
co ntext o f p re- eclam p sia (h y p ertensio n, o ed em a and p ro teinuria o n reagent- strip
test).
• S y m p to m atic treatm ent o f eclam p sia:
T reatm ent o f cho ice is magnesium sulfate by I V infusio n: 4 g d iluted in 0 .9 % so d ium
ch lo rid e to be ad m inistered o ver 1 5 m inutes. T h en infuse 1 g/ h o ur, co ntinue
m agnesium sulfate fo r 2 4 ho urs fo llo wing d elivery o r the last seiz ure. If seiz ure
recurs, give ano ther 2 g by slo w IV injectio n (o ver 1 5 m inutes).
M o nito r urine o utp ut. S to p the treatm ent if urinary o utp ut is less than 3 0 m l/ ho ur
o r 1 0 0 m l/ 4 ho urs.
B efo re each injectio n, verify th e co ncentratio n written o n the am p o ules: there is a
risk o f p o tentially fatal o verd o se. A lway s have calcium gluco nate read y to reverse
the effects o f m agnesium sulp hate in the event o f to xicity .
M o nito r p atellar tend o n reflex every 1 5 m inutes d uring the infusio n. If the p atient
h as m alaise, d ro wsiness, d ifficulty sp eak ing o r lo ss o f p atellar reflex: sto p th e
m agnesium sulfate and inject 1 g o f calcium gluconate by slo w, d irect I V injectio n
O(onvlyerin5thteo a1bs0enmceinoutfems).agnesium sulfate, use diazepam: 1 0 m g slo w IV fo llo wed by
4 0 m g in 5 0 0 m l 5 % gluco se as a co ntinuo us infusio n o ver 2 4 ho urs. I f there is no
veno us access fo r the lo ad ing d o se, give 2 0 m g rectally . I n the event o f treatm ent
failure after 1 0 m inutes, give a seco nd d o se o f 1 0 m g.
F o r d irect I V o r rectal ad m inistratio n d ilute d iaz ep am in 5 % gluco se o r 0 .9 %
so d ium chlo rid e to m ak e a to tal vo lum e o f 1 0 m l.
• O xy gen: 4 to 6 litres/ m inute
• Nursing, hy d ratio n
• U rgent d elivery within 1 2 ho urs
• T reatm ent o f hy p ertensio n: see Hypertension, p age 2 9 1
– Other causes: d uring p regnancy , co nsid er th at seiz ures m ay also be caused by
cerebral m alaria o r m eningitis ( th e incid ence o f th ese d iseases is increased in
p regnant wo m en, see Malaria, p age 1 3 1 and Bacterial meningitis, p age 1 6 5 ).
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sodium valproate P O
C h ild ren o ver 2 0 k g: initial d o se o f 4 0 0 m g in 2 d ivid ed d o ses irresp ective o f
weight; if ne1cessary , increase the do se p ro gressively until the o p tim al d o se fo r
the
ind ivid ual has been reached (usually 2 0 to 3 0 m g/ k g/ d ay in 2 d ivid ed d o ses).
A d ults: initial d o se o f 6 0 0 m g/ d ay in 2 d ivid ed d o ses; increase by 2 0 0 m g/ d ay
every 3 d ay s until the o p tim al d o se fo r the ind ivid ual has been reached (usually
1 to 2 g/ d ay in 2 d ivid ed d o ses).
phenobarbital P O
C hild ren: initial d o se o f 3 to 4 m g/ k g/ d ay at night, increase the d o se p ro gressively
to 8 m g/ k g/ d ay if necessary
A d ults: initial d o se o f 2 m g/ k g/ d ay at night (witho ut exceed ing 1 0 0 m g p er d ay ),
increase the d o se p ro gressively to 6 m g/ k g/ d ay if necessary
Special situation: seizures during pregnancy
– Eclampsia: seiz ures d uring the third trim ester o f p regnancy , m o st co m m o nly in the
co ntext o f p re- eclam p sia (h y p ertensio n, o ed em a and p ro teinuria o n reagent- strip
test).
• S y m p to m atic treatm ent o f eclam p sia:
T reatm ent o f cho ice is magnesium sulfate by I V infusio n: 4 g d iluted in 0 .9 % so d ium
ch lo rid e to be ad m inistered o ver 1 5 m inutes. T h en infuse 1 g/ h o ur, co ntinue
m agnesium sulfate fo r 2 4 ho urs fo llo wing d elivery o r the last seiz ure. If seiz ure
recurs, give ano ther 2 g by slo w IV injectio n (o ver 1 5 m inutes).
M o nito r urine o utp ut. S to p the treatm ent if urinary o utp ut is less than 3 0 m l/ ho ur
o r 1 0 0 m l/ 4 ho urs.
B efo re each injectio n, verify th e co ncentratio n written o n the am p o ules: there is a
risk o f p o tentially fatal o verd o se. A lway s have calcium gluco nate read y to reverse
the effects o f m agnesium sulp hate in the event o f to xicity .
M o nito r p atellar tend o n reflex every 1 5 m inutes d uring the infusio n. If the p atient
h as m alaise, d ro wsiness, d ifficulty sp eak ing o r lo ss o f p atellar reflex: sto p th e
m agnesium sulfate and inject 1 g o f calcium gluconate by slo w, d irect I V injectio n
O(onvlyerin5thteo a1bs0enmceinoutfems).agnesium sulfate, use diazepam: 1 0 m g slo w IV fo llo wed by
4 0 m g in 5 0 0 m l 5 % gluco se as a co ntinuo us infusio n o ver 2 4 ho urs. I f there is no
veno us access fo r the lo ad ing d o se, give 2 0 m g rectally . I n the event o f treatm ent
failure after 1 0 m inutes, give a seco nd d o se o f 1 0 m g.
F o r d irect I V o r rectal ad m inistratio n d ilute d iaz ep am in 5 % gluco se o r 0 .9 %
so d ium chlo rid e to m ak e a to tal vo lum e o f 1 0 m l.
• O xy gen: 4 to 6 litres/ m inute
• Nursing, hy d ratio n
• U rgent d elivery within 1 2 ho urs
• T reatm ent o f hy p ertensio n: see Hypertension, p age 2 9 1
– Other causes: d uring p regnancy , co nsid er th at seiz ures m ay also be caused by
cerebral m alaria o r m eningitis ( th e incid ence o f th ese d iseases is increased in
p regnant wo m en, see Malaria, p age 1 3 1 and Bacterial meningitis, p age 1 6 5 ).
25
