Bowel ischemia: a rare complication of thiopental treatment for status epilepticus.

Abstract

BACKGROUND:

Refractory status epilepticus (RSE) treatment is usually performed with coma induction using an appropriate general anesthetic. Most frequent complications are represented by hypotension and infection. Other side-effects may however be encountered.

OBSERVATIONS:

We describe two patients suffering from acute bowel ischemia after thiopental (THP) treatment for RSE. A 73-year-old man with a complex-patial RSE following an acute stroke received THP (303 mg/kg over 48 h); 36 h after THP discontinuation, he presented abdominal tenderness and lactate elevation. Necrosis of the terminal ileum and colon was seen during surgical exploration; he deceased shortly thereafter. A 21 year-old woman had a cryptogenic de novo generalized-convulsive RSE resistant to 5 attempts of EEG burst-suppression. During the 6th attempt, after THP (840 mg/kg over 150 h) together with mild hypothermia, she developed an ileus with elevated serum lactate; caecum necrosis was observed during surgery. Hypernatremia, acidosis and hyperlactatemia heralded this complication in both patients.

CONCLUSION:

In these two patients, mechanical vascular ischemia may have resulted from drug-induced paralytic ileus. To our knowledge, this is the first report describing this potential fatal side effect in adults with RSE.

• Authors: Carlo Cereda, Mette M Berger, Andrea O Rossetti
• Journal: Neurocritical care (Neurocrit Care) Vol. 10 Issue 3 Pg. 355-8 ( 2009) ISSN: 1541-6933 [Print] United States
• PMID: 19034699 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticonvulsants
• Thiopental

Topics

• Aged
• Anticonvulsants (adverse effects)
• Cecum (blood supply)
• Colon (blood supply)
• Female
• Humans
• Ischemia (chemically induced, diagnosis, therapy)
• Male
• Status Epilepticus (drug therapy)
• Thiopental (adverse effects)
• Young Adult