Bakes et al reported the Denber Seizure Score to distinguish generalized seizures from syncope in patients presenting to the Emergency Department with a loss of consciousness. The authors are from Denver Health Medical Center, University of Colorado at Denver, St. Louis University and Providence Everett Medical Center in Everett, Washington.


Patient selection: loss of consciousness


Outcome: seizure vs syncope



(1) serum bicarbonate in mmol/L

(2) serum anion gap in mmol/L


Denver seizure score =

= (2 * ((anion gap) - 12)) + (24 - (bicarbonate))



Likelihood of Generalized Seizure

< 0


0 to 20


> 20



According to Figure 1:

(1) an anion gap > 22 mmol/L is seen with seizures

(2) an anion gap from 17 to 22 mmol/L favors seizures, especially if the bicarbonate is <= 20 mmol/L

(3) an anion gap from 12 to 17 mmol/L favors syncope

(4) an anion gap < 12 mmol/L indicates syncope in most cases.


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