MGH Status Epilepticus Treatment Protocol 1st line (seizures ongoing for 5-10 mins): - Lorazepam 4mg IV (push over 2mins), If szs not controlled within 5mins, repeat 4mg IV x 1 - If no IV access: Diazepam 20mg rectally (using IV sol’n) or, Midazolam 10mg intranasal/buccal/IM (using IV sol’n). 2nd line (10-30 mins) - If seizures persist - Choose from the following (may be used in combination): 1) Valproic acid 40mg/kg IV (max rate 6mg/kg/min) 2) Levetiracetam 20mg/kg IV (max rate 100mg/min) 3) Phenobarbital 20mg/kg IV (max rate 50-75mg/min) 4) Fosphenytoin 20mg PE/kg IV (max rate 150mg PE/min) or, Phenytoin 20 mg/kg IV (max rate 25-50mg/min) If no effect, can give additional dose: Fosphenytoin 10mg PE/kg IV or Phenytoin 10 mg/kg IV 5) Lacosamide 400mg IV over 5 min (need EKG pre/post) 3rd line (30 - 60 mins) REFRACTORY STATUS EPILEPTICUS: 1) Midazolam (good choice if BP unstable) - Load 0.2mg/kg IV, Repeat q5mins until szs stop (max load 2mg/kg), Maint. infusion 0.1-- 2 mg/kg/hr 2) Propofol - Load 2mg/kg IV, Repeat q5mins until szs stop (max load 10mg/kg), Maint. infusion 1--10mg/kg/hr (< 5 if tx > 48hrs) #MGH #Status #Epilepticus #Treatment #Protocol #algorithm #neurology #management
