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Status epilepticus — USMLE Step 3 MCQ

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HardEmergency MedicineStatus epilepticusUSMLE Step 3

A hospitalized patient taking sotalol develops recurrent self-terminating polymorphic ventricular tachycardia. Between episodes, blood pressure is stable, QTc is 590 ms, potassium is 3.1 mEq/L and magnesium is 1.5 mg/dL. What is the immediate treatment?

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Correct answer: AGive intravenous magnesium, replete potassium, and stop QT-prolonging drugs

The best answer is “Give intravenous magnesium, replete potassium, and stop QT-prolonging drugs”. This is torsades de pointes due to acquired QT prolongation. Intravenous magnesium is first-line even if the serum magnesium were normal; potassium should be brought to a high-normal range and causative drugs stopped. Sustained instability would require unsynchronized shock.

Reference: AHA Adult Advanced Life Support: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/adult-advanced-life-support