In status epilepticus, prolonged muscle activity can lead to metabolic disturbances. Which statement correctly describes this effect and recommended monitoring?

• A. Dehydration causes acidosis.
• B. Alkalosis is expected.
• C. Prolonged muscle activity causes lactic acid buildup and metabolic acidosis with electrolyte shifts; monitor ABG and electrolytes and treat accordingly.
• D. Hyperkalemia has no effect on acidosis.

Answer: (C)

During a prolonged seizure, muscles are in near-constant activity, which increases energy demand beyond what oxygen delivery can meet. This forces muscle cells to rely on anaerobic metabolism, producing lactic acid. The resulting lactic acidosis lowers blood pH, a metabolic acidosis, and the rapid cell turnover also causes electrolyte shifts, particularly involving potassium. Because these changes can be rapid and life-threatening, arterial blood gas analysis and a comprehensive electrolyte panel are essential to assess the degree of acidosis and monitor shifts in electrolytes, guiding treatment. Management focuses on correcting the acid-base disturbance and electrolyte abnormalities while continuing to control the seizure and ensure proper ventilation and oxygenation. Alkalosis is not expected here, and the main mechanism is lactic acidosis from prolonged muscle activity, not dehydration alone.