Approach to convulsive status epilepticus Quiz: Ace Your Exams
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A 26-year-old man is brought to the emergency department by ambulance because of altered mental status. Witnesses report that he collapsed in the grocery store and developed rhythmic stiffening and jerking movements lasting two minutes. He was confused and combative when emergency services arrived. He had a similar second convulsion lasting one minute en route to the hospital. Temperature is 37°C (98.6°F), pulse is 100/min, respirations are 28/min, and blood pressure is 124/80 mmHg. Oxygen saturation is 97% on room air. The patient is drowsy and cannot be fully aroused; he opens his eyes to painful stimuli. His nares are patent. There is an abrasion on the tongue. He has no nuchal rigidity. Cardiopulmonary and abdominal examinations are within normal limits. Laboratory results are shown below. Which of the following is the most appropriate next step in management?
| Laboratory value | Result |
| Sodium | 138 mEq/L |
| Potassium | 4.2 mEq/L |
| Chloride | 95 mEq/L |
| Urine toxicology screen | Negative |
| Finger-stick glucose | 58 mg/dL |
| Hemoglobin | 14 g/dL |
| Platelet count | 300,000/mm3 |
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