Epileptic Emergency Treatment

1. Ask the Owner 2 questions

• Is the patient a known epilepticer who’s getting KBr or Phenobarbital (PB)?
• Does the patient have diabetes and is taking insulin?

Why is that relevant?

• If he isn’t getting KBr —> i.v. full electrolyte infusion
• If he is already getting KBr —> i.v. 0,9% NaCl + 5% Glucose (1:1)
• If he has diabetes he’s probably hyperglycemic

2. First Step in Treatment is Diazepam (0,5 mg/kg i.v.)

• Onset of action: 1-2 Minutes
• If the first dose isn’t working the treatment can be repeated 2-3 times

If an i.v.- access isn’t possible try Diazepam rectal tubes

• If he isn’t getting PB already: 1 mg/kg
• If he is getting PB: 2 mg/kg
• Onset of action: 15-20 Minutes

OR

Midazolam intranasal with an atomizer (0,2 mg/kg)

• Onset of action: 1-5 Minutes

3. Next Step: Phenobarbital (10 mg/kg i.v.)

• Give PB even if Diazepam worked, because the effect of Diazepam will only last for 20-30 minutes
• Can be repeated once if the patient isn’t already getting PB
• Onset of action: 15-20 Minutes

CAVE: If the Patient is already getting PB always check the blood level before treating him with PB!

4. If the seizures persist or occure again within the next 2 hours: Levetiracetam (20 mg/kg slowly i.v.)

• Can be repeated 2 times

5. Start Diagnostics

• Hypoglycemia: 3-5 ml/kg 20% Glucose i.v.
• Hypocalcemia: 0,5 – 1 ml/kg 10% Ca-Carbonat slowly i.v. (CAVE: Bradycardia)
• Temperature: > 40 degree Celcius —> cool him down < 39,5 degree Celcius —> stop or will cool down too much

6. If the Seizures persist or occur again ask yourself if Diazepam worked the first time

If YES:

Diazepam

• 0,5 mg/kg i.v. Bolus followed by…
• 0,1 – 0,5 mg/kg/h (continous infusion), 30 mg Diazepam in 250 ml 5% Glucose
• If it works reduce Diazepam in 6-8 hours
• If it doesn’t work put him under anaesthesia

If NO:

Pentobarbital

• 1-2 mg/kg i.v. Bolus followed by…
• 1-5 mg/kg/h continous infusion

Propofol

• 4-8 mg/kg i.v. Bolus followed by…
• 4-8 mg/kg/h continous infusion

Cave: Both those drugs can cause depression of breathing, so the patient has to be under surveillance all the time!

Inhalation anaesthesia

Simultaneous to all 3 of them: PB on maintenance dose of 2,5 mg/kg i.m. (2x/day) Wake the patient up after 6-8 hours

Step one, you say we need to talk

Two things, you ask, be quick, keep it short

Thirst you really must be sure

If the dog has had seizures before

So listen up, cause if he did

Ask if he takes potassium bromid.

Or maybe he gets other meds

For example barbiturats.

Now start your treatment

With diazepam

PB is next, on the treatment plan

And now you should stay up with him all night

And that is how to save a life

If it still does not improve

Breath in, breath out and make another move

Try Levetiracetam

Next step would be Diazepam

If that hasn‘t worked before

You still got other things in store

Anesthesia makes him sleep

But careful that will not be cheap

Now that’s your treatment

Haven’t lost him yet

He’s save for now and he will be

But still you should stay up with him all night

And that is how to save a life

Based on the treatment plan by Prof. Dr. Thomas Flegel (University of Leipzig, Germany)