UMEM Educational Pearls

Category: Toxicology

Title: Risk Factors for Complications of Drug-Induced Seizures

Keywords: hyperglycemia, acidosis, seizures (PubMed Search)

Posted: 6/16/2011 by Fermin Barrueto, MD (Updated: 2/24/2020)
Click here to contact Fermin Barrueto, MD

The true incidence of drug-induced seizure is very difficult to determine, however, a nice poison center study attempted to determine clinical factors associated with complications (potentially life-threatening) of drug-induced seizures. They found 3 predictors that demonstrated statistically significant associations:

  1. Stimulant Exposure (i.e. cocaine, amphetamines etc)
  2. Initial acidosis
  3. Hyperglycemia (limitation they do not give incidence of DM)

They found a 60% complication rate in drug-induced seizures which is much higher than epileptic seizures. Makes sense since these patients are often sedated/altered or vomiting.

Stimulant Exposure is much more prominent in this population and has increased in mortality.

Interesting point with hyperglycemia, may be a novel marker for poor prognosis. Several studies have confirmed an association between hyperglycemia and increased neuronal injury and mortality in other settings like CVA and TBI.

Take home point - Drug-induced Seizure has a high complication rate in the ED. Watch for the 3 predictors as that may clue you in to the increased risk.

References

Thundiyil JG et al. J Med Toxicol (2011) 7:16-23