Phase II

After approximately 30 minutes of continuous seizure activity, phase II begins with loss of cerebral autoregulation, decreased cerebral blood flow, increased intracranial pressure, and systemic hypotension. Metabolic demand is still high; however, the body is no longer able to compensate. The systemic changes that may occur include hypoglycemia, hyperthermia, respiratory failure, hypoxia, respiratory and metabolic acidosis, hyperkalemia, hyponatremia, and uremia. It is important to note that motor activity may not be clinically evident during prolonged seizures, but the electrical activity may still exist. This is referred to as subclinical seizure activity and needs to be recognized and treated aggressively.

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