Initial management of pediatric status epilepticus
Timeline
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General Considerations
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Seizure Treatment
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0-5 minutes
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- Supportive care
- Establish IV/IO access
- Check blood glucose
- If fever, acetaminophen 15 mg/kg rectally
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- Benzodiazepine: first dose
- IV/IO access establised
- Lorazepam 0.1 mg/kg IV or IO (max = 4 mg), OR
- Diazepam 0.2 mg/kg IV or IO, (max = 8 mg)
- IV or IO access not achieved within 3 minutes:
- Buccal midazolam 0.2 mg/kg (max = 10 mg), OR
- IM midazolam 0.1 to 0.2 mg/kg (max = 10 mg), OR
- Rectal diazepam (Diastat gel or injection solution given rectally) 0.5 mg/kg (max = 20 mg)
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5-10 minutes
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- Give antibiotics if signs of sepsis or meningitis
- POC electrolytes, if available
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- Benzodiazepine: second dose
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10-15 minutes
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- Antiepileptic: first therapy
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15-30 minutes
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- Consider intubation, if not already performed
- Pediatric neurology consultation
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- Antiepileptic: second therapy
- Fosphenytoin^ (if not already given) 20 mg PE per kg IV or IO, OR
- Valproate (if not already given) 20 to 40 mg/kg IV or IO, OR
- Phenobarbital (if not already given) 20 mg/kg IV or IO, (max = 1 g; 10 mg/kg if phenobarbital already given), OR
- Levetiracetam (if not already given) 40 mg/kg IV or IO,
- If isoniazid toxicity suspected, pyridoxine
- Infants (<1 year): 100 mg IV or IO in
- Otherwise 70 mg/kg IV or IO (max = 5 g)
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^May be ineffective for toxin-induced seizures and contraindicated in cocaine toxicity