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Critical care management of status epilepticus: A retrospective chart review with focus on antiepileptic drugs
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
2018 (English)Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

Introduction: Status epilepticus (SE) is a neurological emergency associated with significant morbidity and mortality that needs to be promptly treated. Despite of the condition severity, there is a lack of data supporting the preferred therapy selection. Aims: The aim of the present study was to evaluate the critical care management of SE in a teaching hospital with specific focus on antiepileptic drug (AED) use. The focus was on choice, dosing, therapeutic drug monitoring (TDM) and effectiveness of individual AEDs. Methods: A retrospective chart review was performed on 55 records from patients admitted with SE at the University of Alberta Hospital, Edmonton, Canada, between January 2015 to December 2016. Patient medical records were requested from the University of Alberta Hospital based on ICD-10-CA codes for SE. Data were abstracted from both paper, as well as electronic charts and managed using REDCap database capture tool. Adherence to the guidelines for the treatment of SE was assessed. Moreover, TDM of phenytoin, the most commonly used AED, was evaluated. In addition, the group of patients in which phenytoin was effective was compared to those who did not achieve seizure remission while on phenytoin, using student’s t-test for continuous variables and χ2 test for categorical variables. Results: Overall, most patients were treated according to the current guidelines regarding choice and order of agents. However, variability was observed regarding AEDs dosing. The results suggest that fixed doses of phenytoin might occur. A great variability was observed when converting the doses from mg to weight-adjusted doses (mg/kg). With regards to phenytoin TDM, the reason for phenytoin bolusing or dose increase was unclear in six out of 18 occasions (33 %). Moreover, a trend towards increasing phenytoin serum levels with increasing age was observed. Phenytoin turned out to be effective in 50 % of the patients. A statistical significant difference of a lower mean age was observed in the group of patients in which phenytoin was effective. Conclusion: The findings indicates that there might be room for optimization of phenytoin TDM and the findings emphasize the importance of an accurate documentation of seizure activity to enable an individualized drug therapy. Moreover, TDM should be carried out closely when managing AED therapy in elderly, especially when using phenytoin. In addition, fixed dose phenytoin might result in underdosing or subtherapeutic levels and weight-adjusted dosing is recommended.  

Place, publisher, year, edition, pages
2018. , p. 31
National Category
Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:uu:diva-355903OAI: oai:DiVA.org:uu-355903DiVA, id: diva2:1231544
External cooperation
University of Alberta
Educational program
Master of Science Programme in Pharmacy
Supervisors
Examiners
Available from: 2018-10-10 Created: 2018-07-07 Last updated: 2018-10-10Bibliographically approved

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