Breakthrough Seizure in Elderly Woman on Thiazide Diuretic
Work through a breakthrough seizure in a patient whose epilepsy seemed controlled — and uncover a metabolic precipitant hiding in a recently changed medication. Practise safe electrolyte correction and assess for occult injury after an elderly fall.
Presentation
A 73-year-old woman with known focal epilepsy is found on the floor by her daughter after a brief episode of left arm shaking, now mildly confused.
Learning goals
- Identify metabolic derangements, particularly hyponatraemia, as precipitants of breakthrough seizure rather than attributing the event solely to epilepsy
- Manage hyponatraemia correction safely to avoid osmotic demyelination syndrome by calculating an appropriate rate of rise
- Assess for fall-related occult injury and review precipitating medications including the newly started thiazide diuretic
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