Status eclampticus, postconvulsive changes and differential diagnosis
THE CONTEXT
Eclampsia must be distinguished from other causes of convulsions or coma during pregnancy or soon afterward.
Status eclampticus and postconvulsive findings
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Eclamptic fits occurring in quick succession are called status eclampticus.
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Following convulsions, temperature, pulse rate, respiratory rate and blood pressure usually rise.
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Urinary output is markedly diminished, proteinuria is pronounced and blood uric acid is raised.
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Extensive tongue bite injury usually occurs during the clonic stage.
Differential diagnosis
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Consider epilepsy, hypoglycemia, encephalitis, meningitis and PRES.
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Other listed possibilities are cerebral venous thrombosis, hypertensive encephalopathy, cerebral malaria in the tropics, intracranial tumors and HIE.
Features supporting eclampsia
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Fits or coma during pregnancy or soon afterward, accompanied by edema, hypertension and proteinuria without a previous history of convulsions, point toward eclampsia.
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In doubtful cases, observation in an obstetric unit is desirable until the final diagnosis is established.