ED Pathway for Evaluation/Treatment of Children with Status Epilepticus

Standard Medications for the Treatment of Status Epilepticus

IMMEDIATE THERAPY TO STOP SEIZURE
ANTICIPATE NEED FOR NEXT MEDICATION

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

1st Agent

Lorazepam
1st dose

2nd dose


0.1

0.1


4

2


IVP
 

2nd Agent

Phenytoin* 25 None 3 mg /kg/min, (Max 50mg/min)

Caution

History of arrhythmias
Concern for hypotension
Infuse in NaCl only

3rd Agent

Choose ONE Phenobarbital or Valproate or Levetiracetam
Phenobarbital 20 None 1 mg/kg/min
(Max 30 mg/min)

Caution

Concern for hypotension
Specific concern for maintaining cerebral perfusion pressure
Valproate 40 None 5 mg/kg/min

Restrictions

Do not use if:
Patients < 2 years old
Concern for liver/metabolic disorder
Levetiracetam 20 1500 Infuse over 10 minutes

Considerations

Limited efficacy data in SE
May increase seizures if viral/bacterial CNS infection (anecdotal data)
Caution with repeated dosing if renal impairment
*Adjust dose as needed for patients maintained on Phenytoin