Related Experiment Video
Updated: Jul 6, 2026

Behavioral Characterization of Pentylenetetrazole-induced Seizures: Moving Beyond the Racine Scale
Published on: July 8, 2025
Massive tongue swelling in refractory status epilepticus treated with high-dose pentobarbital
Teng Ji1, Alexander Y Zubkov, Eelco F M Wijdicks
1Division of Child and Adolescent Neurology, Mayo Clinic, Rochester, MN, USA.
Introduction:
The potential causes of acquired macroglossia are extensive. The authors report two cases of subacute marked tongue swelling resulting in airway compromise in patients with refractory status epilepticus requiring prolonged pentobarbital coma.
Method:
The hospitalization histories of the reported patients were retrospectively reviewed.
Result:
The tongue swelling completely resolved in one case and significantly improved in the other after discontinuation of pentobarbital infusion or switching to phenobarbital. The authors speculate that the causes were multifarious, likely a combination of localized angioedema due to barbiturate vehicle and triggered by an initial tongue bite.
Conclusion:
Progressive tongue swelling causing airway obstruction can occur well beyond the acute phase of status epilepticus and may potentially cause problems with extubation in nontracheotomized patients.
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Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals.
