and Hyperthermia Associated with Poisoning or D癫痫发作和热疗与中毒或D相关课件.pptVIP

Seizures and Hyperthermia Associated with Poisoning or Drug Overdose Kent R. Olson, MD, FACEP, FACMT Medical Director, San Francisco Division California Poison Control System University of California, San Francisco Causes of Status Epilepticus in the ED 1980-1989 Urban SF Hospital – 154 pts Anticonvulsant drug withdrawal: 39 Alcohol-related: 39 Drug Toxicity: 14 (9%) CNS infection: 12 Lowenstein DH Alldredge BK et al: Neurol 1993; 43 Outline Causes of drug-induced seizures (“drug” = drug or poison) Consequences and complications of drug-induced seizures Anticonvulsants for drug-induced seizures Management of drug-induced hyperthermia Case A 27 yo man was admitted with an unknown drug overdose, unresponsive but breathing. Pupils 5 mm. Absent bowel sounds. Frequent jerking movements. BP 120/80, HR 100/min ECG: Case (continued) Shortly after admission he developed recurrent generalized seizures. With the onset of seizures, the QRS interval increased to 0.20 sec. The BP fell to 70 mm systolic, and dopamine and norepinephrine were given. Case (continued) Three hours after admission, the rectal temperature was noted to be 107 F. Despite intensive supportive care, he developed multi-organ failure and died. Complications of Drug-Induced Seizures Hypoxemia Shock Brain Damage Hyperthermia Rhabdomyolysis Metabolic acidosis Other drug-specific complications Common Causes of Drug-Induced Seizures Cocaine, amphetamines, other stimulants Tricyclic antidepressants Other antidepressants antipsychotics Diphenhydramine Isoniazid Many others Olson KR et al: Am J Emerg Med 1993; 11:565-568 Treatment of Drug-Induced Seizures ABCD’s: Airway Breathing Circulation Dextrose Anticonvulsants Specific antidote, if available Cooling measures Anticonvulsants for Drug-Induced Seizures Tricyclic and Related Antidepressants Cardiotoxicity often worsened by seizures Use bicarb to restore/maintain pH 7.4 Muscle twitching, absent sweating increase risk of hyperthermia Consider