title: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, CHUV BH-07, Lausanne, 1011, Switzerland.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cereda
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Rossetti
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects*; D002432:Cecum / Q000098:blood supply*; D003106:Colon / Q000098:blood supply*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D013226:Status Epilepticus / Q000188:drug therapy*; D013874:Thiopental / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D013874:Thiopental