Adjunctive enteral phenobarbital for adult status epilepticus: a brief report
A 53-year-old male without prior comorbidity was admitted due to acute extensive anterior wall ST elevated myocardial infarction with cardiac arrest. He had three cardiac arrests with successful cardiopulmonary resuscitation (CPR) for 8, 2, and 2 minutes. The patient was comatose and developed acute kidney injury, hyperphosphatemia, mild hepatitis, and ventricular tachycardia after the CPR. He was given IV amiodarone and an intra-aortic balloon pump. The patient had a GTCSE from hypoxic ischemic encephalopathy. His SE was not controlled after treatment with IV diazepam (10 mg, four times) or IV sodium valproate (1,200 mg, twice). An EEG showed persistent epileptic discharge, which was found starting at the left temporal area and secondary to both cerebral hemispheres. The seizures were successfully controlled with 960 mg PB via NG tube feeding. The PB level was 32.51 μg/mL (10–40 μg/mL), and the free form of sodium valproate was 32.51 μg/mL (5–10 μg/mL) 48 hours later. He was free of seizures with the maintenance dose of PB of 180 mg per day and returned home completely recovered.