ED Pathway for Evaluation/Treatment of Children with Status Epilepticus

Treatment for Status Epilepticus if No IV/IO Available

  Medication Dose (mg/kg) Max Dose (mg) Considerations

1st Agent

Diazepam PR
1st dose

2nd dose


0.5

0.25


20

10

Wait 5 minutes after initial dose
Give 2nd dose if seizure persists
If seizure persists, proceed to Midazolam

2nd Agent

Midazolam IM, buccal

Phenobarbital IM

 

Fosphenytoin IM

0.2

 

20

 

20

10

 

None

 

None

Give dose; wait 5 minutes

 

Onset action 15-20 minutes

 

NOTE:

This is prepared by Pharmacy; the ED should alert Pharmacy when this is needed
Peak effect 5-30 minutes
Higher plasma levels are achieved more rapidly, when the drug is given as two divided gluteal doses