Laboratory Tests for Status Epilepticus Patients

Essential Laboratory Tests

• For patients in status epilepticus, comprehensive laboratory testing is essential to identify underlying causes, guide treatment, and prevent complications, including glucose and electrolyte abnormalities which are the most common treatable metabolic causes, as recommended by the American College of Emergency Physicians 1, 2
• Blood glucose should be checked immediately in patients with status epilepticus, as hypoglycemia is one of the most common treatable causes of seizures, according to the American College of Emergency Physicians 1
• Serum sodium levels should be evaluated in seizure patients, as hyponatremia is a frequent abnormality that can both cause and result from prolonged seizure activity, as noted by the American College of Emergency Physicians 1
• A complete blood count should be performed to evaluate for infection, anemia, or other hematologic abnormalities that may trigger or complicate status epilepticus, as suggested by the guideline society 3, 4
• A basic metabolic panel should be assessed to evaluate electrolyte disturbances, renal function, and acid-base status in patients with status epilepticus, according to the guideline society 3, 4
• Toxicology screening should be performed in patients with suspected substance use, withdrawal, or medication overdose as potential causes of status epilepticus, as recommended by the guideline society 3, 4
• Antiepileptic drug levels should be checked in patients with known epilepsy to assess for medication non-compliance or subtherapeutic levels, according to the American College of Emergency Physicians 1

Additional Tests Based on Clinical Presentation

• An arterial blood gas should be performed in patients with respiratory compromise or suspected metabolic acidosis, as recommended by the Society of Critical Care Medicine 5
• A pregnancy test should be performed in women of childbearing age with status epilepticus, as suggested by the guideline society 4
• A lumbar puncture should be considered in patients with suspected infection, such as meningitis or encephalitis, especially in febrile patients, according to the guideline society 4

Neurological Testing

• An emergent EEG should be considered in patients with persistent altered consciousness, suspected nonconvulsive status epilepticus, or those receiving long-acting paralytics or in drug-induced coma, as recommended by the American College of Emergency Physicians 6, 7
• An emergent EEG should be performed to guide treatment efficacy in patients with refractory status epilepticus, according to the American College of Emergency Physicians 7

Special Considerations

• Glucose control should be maintained at moderate levels (108-144 mg/dL) rather than tight control, as hypoglycemia can trigger seizures, as recommended by the Society of Critical Care Medicine 5
• Electrolyte replacement should be performed promptly but cautiously, especially sodium imbalances, in patients with status epilepticus, according to the American College of Emergency Physicians 1

Magnesium Assessment in Status Epilepticus

Electrolyte Evaluation

• In adults presenting with status epilepticus, serum magnesium should be measured because hypomagnesemia can both precipitate and perpetuate seizure activity, representing a potentially reversible metabolic trigger. 8