38-08: Poisoning or Overdose–Related Seizures

ASSESSMENT & COMPLICATIONS

Seizures may be caused by many poisons and drugs, including amphetamines, antidepressants (especially tricyclic antidepressants, bupropion, and venlafaxine), antihistamines (especially diphenhydramine), antipsychotics, camphor, synthetic cannabinoids and cathinones, cocaine, isoniazid (INH), chlorinated insecticides, piperazines, tramadol, and theophylline. The onset of seizures may be delayed for up to 18–24 hours after extended-released bupropion overdose.

Seizures may also be caused by hypoxia, hypoglycemia, hypocalcemia, hyponatremia, withdrawal from alcohol or sedative-hypnotics, head trauma, central nervous system infection, or idiopathic epilepsy.

Prolonged or repeated seizures may lead to hypoxia, metabolic acidosis, hyperthermia, and rhabdomyolysis.

TREATMENT

Administer lorazepam, 2–3 mg, or diazepam, 5–10 mg, intravenously, or—if intravenous access is not immediately available—midazolam, 5–10 mg intramuscularly. If convulsions continue, administer phenobarbital, 15–20 mg/kg slowly intravenously over no less than 30 minutes. (For drug-induced seizures, phenobarbital is preferred over phenytoin or levetiracetam.) Propofol infusion has also been reported effective for some resistant drug-induced seizures.

Seizures due to a few drugs and toxins may require antidotes or other specific therapies (as listed in Table 38–2).