Clinical Reasoning: A 40-Year-Old Man With Refractory Status Epilepticus After Small Bowel Resection for Volvulus

Evaluating and treating patients with altered mental status in the intensive care unit can be complicated. In this case, a 40-year-old man presented with small bowel volvulus and his course was complicated by super-refractory status epilepticus (SRSE). Repeated attempts to wean ketamine infusion led to recurrence of SE. This case details the approach for evaluation and management of SRSE. Owing to the patient's intolerance to ketamine infusion weaning, we opted for the off-label use of the oral NMDA receptor antagonist memantine, which successfully supported the weaning process from ketamine infusion.