[Lactic acidosis in the postictal state]

Area of Science:

• Neurology
• Emergency Medicine
• Clinical Diagnostics

Background:

• Epilepsy affects 30 per 100,000 people annually in the Netherlands.
• Generalized seizures can present with severe metabolic lactic acidosis.

Observation:

• Two emergency department cases presented with generalized seizures and severe lactic acidosis.
• Initial assessment did not suggest causes other than the seizure.

Findings:

• Arterial blood samples repeated 1-2 hours later showed normalized pH and lactate levels.
• Postictal hyperlactatemia is often self-limiting in seizure patients.

Implications:

• Routine arterial blood sampling for lactic acidosis post-seizure may have limited diagnostic value.
• Persistent hyperlactatemia warrants further investigation for underlying pathologies.
• Repeating arterial blood samples after a few hours is advisable for persistent cases.