Do you give benzo's to a hypoglycemic seizure?

[Ace844]

Hi All,

Perhaps soemone could clarify for me....What is the issue with using both medicines as an initial treatment regime....Yes, I understand that you need to find, and treat the underlying etiology of the disorder. But truth of the matter is, most seizure patients ARE HYPOGLYCEMIC AS A RESULT OF THEIR SEIZURE ACTIVITY!!!! :wink: !! Yes, with diabetics, it is an important distinction to make, but only AFTER YOU'VE CORRECTED THE LIFE THREATENING DISORDERS FIRST!!

Also, it is important to note that benzo's merely stop the motor activity end of the seizure and that if your patient is truely atatus seizing, their brain will most likely continue to seize after the benzos. I think that the benzo's should be given and simultaneously, a dex stick performed, and then D50/Glucagon, thiamine should be given as needed...

Out here,

Ace844

[1EMT-P]

I would give D50 first, then I would recheck the patients blood sugar if the patients BS was still low I would give an additional dose of D50. If the patient did not respond then I would give 5-10 Mg's of Valium IV.

If I didn't have IV access then I would consider giving 1 mg of Glucagon IM & 5-10 Mg's of Valium PR.

[medic327]

HERE THE THING I JUST RECENTLY HAD A CASE LIKE THIS I GAVE THE D50 FIRST AND THE SZ STOP. THIS WAS A HARD CHOICE ,BUT KNOW THE PT. WAS IDDM I CHOSE THE SUGAR FIRST

[Ace844]

HERE THE THING I JUST RECENTLY HAD A CASE LIKE THIS I GAVE THE D50 FIRST AND THE SZ STOP. THIS WAS A HARD CHOICE ,BUT KNOW THE PT. WAS IDDM I CHOSE THE SUGAR FIRST

1EMT-P Posted: Wed Jul 13, 2005 3:01 am Post subject:

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I would give D50 first, then I would recheck the patients blood sugar if the patients BS was still low I would give an additional dose of D50. If the patient did not respond then I would give 5-10 Mg's of Valium IV.

If I didn't have IV access then I would consider giving 1 mg of Glucagon IM & 5-10 Mg's of Valium PR.

Ace844 Posted: Sat Jul 09, 2005 3:50 pm Post subject: Conjunctive therepies

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Hi All,

Perhaps someone could clarify for me....What is the issue with using both medicines as an initial treatment regime....Yes, I understand that you need to find, and treat the underlying etiology of the disorder. But truth of the matter is, most seizure patients ARE HYPOGLYCEMIC AS A RESULT OF THEIR SEIZURE ACTIVITY!!!! !! Yes, with diabetics, it is an important distinction to make, but only AFTER YOU'VE CORRECTED THE LIFE THREATENING DISORDERS FIRST!! Also, it is important to note that benzo's merely stop the motor activity end of the seizure and that if your patient is truely status seizing, their brain will most likely continue to seize after the benzos. I think that the benzo's should be given and simultaneously, a dex stick performed, and then D50/Glucagon, thiamine should be given as needed...

Out here,

Ace844

Hi All,

Please reread my preceeding post. I think that it's important to note that the Active Seizure is the more life threatening event here, and if your patient is actively seizing, THEY ARE NOT BREATHING!!!! :idea: :idea: :roll: :!: Yes a diabetic needs their sugar imbalence corrected, but even a diabetic who is seizing that get D50 or Glucagon and continues to seize will VERY QUICKLY burn through that additional sugar, also the hypoxia will do as much or more brain/neuro damage than if it was a pure isolated hypoglycemic even....just my .02, IMHLO...

Hope this helps..,

Ace844

[rdenman26]

If the seizure has an identifiable cause that you can treat then you should do that. But some times you may have to control the seizure with rectal diazapam for example before you can safely get near the patient with a needle for glucose or glucagon or IV diazepam,

[Asysin2leads]

That's basically what I was saying, rdenman, but I said 10 of midazolam IM rather than 5 diazepam rectally. In an actively seizing patient, most times you have to control the seizure before you can treat the cause.

[1EMT-P]

It doesn't make sense to give this patient Versed, if all they need is Glucose. Why not give them O2 and D50 first then if they don't respond give them Ativan or Valium.

Remember treat the whole patient, not just the signs and symptoms .

[buddha]

Active seizures lead to hypoxia, obstructed airway, and if untreated, death. Trying to secure good IV access for a D50 bolus in an actively seizing patient is akin to trying to shove a wet noodle up a wildcat's butt, not to mention the added potential for patient injury as you try to hold an arm secure enough to get a good line.

Break the seizure and treat the hypoglycemia after. Don't forget that glucagon takes 10-15 minutes to really break enough sugar loose, which is a long time for someone to seize. Suppose you get a line and begin D50, but the patient pulls the IV while you are trying to administer - now you have to restart another difficult IV. Remember that extravasation of D50 causes tissue necrosis.

Rectal or nasal benzos work just fine and are very quick onset. Breaking the seizure first will make it much easier and safer for both you and the patient.

[Ace844]

Hi All,

To further muddy the waters here a bit, I also respectfully present for your consideration the possibility that not every patient who happens to be a diabetic and whom then develops seizure activity, who or what is to say that their seizure was caused by a diabetic disorder in the first place???!!!! :?: :idea: What about a comprehensive exam in this case especially!! :arrow:

out here,

Ace844

[buddha]

In my earlier post, I stated that my preference would be to break the seizure first - and then follow with glucose check to confirm or rule out hypoglycemia.

Ace is right - every patient should get the same thorough evaluation, regardless of what you know (or think you know) about a patient. Providing care based solely on a bracelet or on the word of a bystander will eventually get you into trouble. How many causes for seizure can you think of - hypoxia, hypoglycemia, fever, toxins, cva, tumor, etc. Evaluation done properly is a scientific method of examining all possibilities and systematically ruling them in or out. The presenting problem is an active seizure - break the seizure and then work to determine and treat the cause of the presenting problem.

Remember the common test question about a driver observed operating erratically who crashes into a pole and is found acting "intoxicated"?? Are his actions the cause of the crash (medical, ETOH), or did the crash cause his current state (head trauma)?? Which came first - the chicken or the egg??