Refractory Hypoglycemia with Generalized Convulsive Status Epilepticus in Suspected Propranolol Overdose: Is Early Intubation the Key?

Abstract

There are many ways to manage status epilepticus. The rationale for aggressive treatment of generalized convulsive status epilepticus lies solely on the premise that best outcomes rely upon rapid seizure control. Metabolic and toxic seizures can be particularly refractory to therapy, exposing a patient to the threat of aspiration, hyperkalemia, rhabdomyolysis, hyperthermia, myocardial infarction, and arrhythmias.1 The role of intubation is controversial. Neurologists tend to view intubation as a form of “treatment failure”, reflecting inability to treat the seizure with traditional agents.1 However, it is our opinion that intubation is often the key therapeutic intervention to not only control the seizure, but prevent its deadly complications. In our case report, we highlight the emergent airway management of a 29-year-old pre-morbidly healthy female who was referred to us from a secondary care center with generalized convulsive status epilepticus and refractory hypoglycemia, following an alleged history of propranolol overdose.