Do you administer intravenous (IV) fluids to a patient experiencing a seizure?

From the Guidelines

Intravenous fluids are not routinely given for seizure patients unless there are specific indications, such as dehydration, hyperthermia, vomiting with risk of aspiration, or hypoglycemia, as the primary treatment focuses on antiepileptic medications and airway protection 1. The primary treatment for active seizures focuses on antiepileptic medications such as benzodiazepines (lorazepam 0.1 mg/kg IV, as seen in Algorithm B for convulsive status epilepticus 1), followed by second-line agents like levetiracetam or phenobarbital if seizures persist.

• The use of IV fluids may be appropriate in certain circumstances, such as:
  • Dehydration
  • Hyperthermia from prolonged seizure activity
  • Vomiting with risk of aspiration
  • Hypoglycemia, in which case dextrose solution would be indicated
• When fluids are needed, isotonic solutions like normal saline are typically used, as recommended for fluid resuscitation in patients at risk for acute kidney injury or with AKI 1. The rationale for limited fluid administration is that most seizure patients do not have significant fluid deficits, and excessive fluids could potentially worsen cerebral edema if present, thus prioritizing the control of seizure activity and airway protection over routine fluid administration 1.

From the Research

Seizure Treatment

• The provided studies do not directly address the administration of fluids to seizure patients, but rather focus on the use of anticonvulsant medications and other treatments for status epilepticus and seizure emergencies 2, 3, 4, 5.
• One study mentions the use of cold Ringer's lactate solution to terminate intraoperative stimulation-evoked seizures, suggesting that fluids may play a role in seizure management in certain contexts 6.
• The primary treatments discussed in the studies are benzodiazepines, such as lorazepam and diazepam, which are effective in controlling seizures and status epilepticus 2, 3, 4, 5.
• The studies compare the efficacy and safety of different anticonvulsant medications, including lorazepam, diazepam, phenytoin, and midazolam, in the treatment of status epilepticus and seizure emergencies 2, 3, 4, 5.

Fluid Administration

• There is limited information available on the administration of fluids to seizure patients in the provided studies.
• The study on cold Ringer's lactate solution suggests that fluids may be used to help terminate seizures in certain situations, but this is not a direct answer to the question of whether fluids are given to seizure patients 6.
• Further research would be needed to determine the role of fluid administration in seizure management.