Adjunctive enteral phenobarbital for adult status epilepticus: a brief report
A 57-year-old male patient with history of diffuse systemic sclerosis, hypothyroidism, and myositis was admitted with an acute fever with seizures for 1 day. A CT scan of the brain showed normal findings with no white blood cells in his CSF. He received piperacillin/tazobactam and 1,000 mg oral levetiracetam per day, and the seizures were controlled. During the admission, he had bronchial secretion obstruction with hypoxemia and severe metabolic acidosis, and cardiac arrest. After a successful CPR, he was comatose and developed GTCSE. An EEG showed persistent epileptic discharges in the right temporal area, compatible with SE. The seizures were uncontrolled after 5 mg IV midazolam and an IV fentanyl infusion, at 5 mL/hour. Finally, 900 mg PB, via NG tube feeding, was prescribed, with successful seizure control. He was given a maintenance dose of 180 mg PB. The PB level was 31.61 μg/mL (10–40 μg/mL) at 4 hours after PB administration. A repeat CT brain scan showed posterior reversible encephalopathy syndrome. The patient completely recovered.