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Definition

• A state of continuous seizures or repetitive, discrete seizures with impaired consciousness in the interictal period
  • Duration
    • Traditional criterion: 15–30 minutes
    • Practical criterion: duration prompting acute use of anticonvulsant therapy; typically > 5 minutes
  • May occur with all type of seizures: grand mal (tonic-clonic) status, myoclonic status, petit mal status, and temporal lobe (complex partial) status
  • Associated with major cerebral and systemic physiologic changes
    • Initial stage (first 30–60 minutes)
      • Cerebral metabolism is greatly increased because of seizure activity, but physiologic mechanisms are sufficient to meet the metabolic demands.
      • Cerebral: increased blood flow, increased metabolism
      • Autonomic and cardiovascular: hypertension, increased cardiac output, massive catecholamine release, tachycardia, arrhythmias, hyperpyrexia
      • Metabolic: lactic acidosis, hyperglycemia
    • Decompensated phase
      • Cerebral metabolic demands cannot be fully met, resulting in hypoxia and altered cerebral and systemic metabolic patterns.
      • Cerebral: hypoxia, hypoglycemia, increased intracranial pressure
      • Autonomic and cardiovascular: hypoxia, hypotension, hyperpyrexia
      • Metabolic: hypoglycemia, hyponatremia, hyperkalemia, metabolic acidosis
  • Generalized status is life threatening when accompanied by hyperpyrexia, acidosis (from prolonged muscle activity), and respiratory or cardiovascular compromise.

The Harrison's Practice Preview allows you to view 5 FREE complete topics or conduct a search that delivers abstracts for more than 450 medical topics. For full access, please subscribe today!