Seizure control for poisonings
Always consider hypoglycaemia as a possible cause of seizures in poisoning and check the blood glucose concentration urgently. If required, treat hypoglycaemia with intravenous glucose, aiming for a blood glucose concentration between 4 and 8 mmol/L.
For adults with hypoglycaemia, use:
1 glucose 50% 50 mL intravenously, by slow injection, via a large peripheral vein seizure control for poisonings
OR
1 glucose 10% 250 mL intravenously, by slow injection, via a large peripheral vein.
For children with hypoglycaemia, use:
glucose 10% 2.5 mL/kg intravenously, by slow injection, via a large peripheral vein.
If seizures due to poisoning are persistent (not self-limiting within minutes) or recurrent, treat with an intravenous benzodiazepine. Use:
1 midazolam 5 to 10 mg (child: 0.15 mg/kg up to 10 mg) intravenously, over 2 to 5 minutes; repeat once after 5 minutes if seizures continue seizure control for poisonings midazolam
OR
1 diazepam 5 to 10 mg (child: 0.1 to 0.3 mg/kg up to 10 mg) intravenously, over 2 to 5 minutes; repeat once after 5 minutes if seizures continue. seizure control for poisonings
If intravenous access cannot be obtained quickly, use:
1 midazolam 5 to 10 mg (child: 0.15 mg/kg up to 10 mg) intramuscularly; repeat once after 5 minutes if seizures continue midazolam
OR
1 midazolam (adult and child) 0.3 mg/kg up to 10 mg buccally or intranasally. midazolam
For refractory seizures due to poisoning, seek advice from a clinical toxicologist. If indicated, use:
1 phenobarbital (phenobarbitone) 20 mg/kg up to 2 g (child: 20 mg/kg up to 1 g) intravenously, over 30 minutes1 seizure control for poisonings phenobarbital
OR
2 levetiracetam (adult and child) 20 mg/kg up to 2 g in sodium chloride 0.9% 100 mL or glucose 5% 100 mL intravenously, over 15 minutes. A concentrated solution of up to 50 mg/mL levetiracetam may be used. seizure control for poisonings
Do not use phenytoin because it is ineffective for drug-induced seizures and drug withdrawal. Phenytoin’s sodium channel blocking action may increase the risk of arrhythmias.