Management of Convulsive Status Epilepticus in children
Stabilization Phase (Seizure 0-5 minutes):
• Check and maintain ABC (airway, breathing and circulation).
• Give high flow oxygen.
• Check blood glucose level.
• Establish Intravenous (IV) access.
• Consider CBC, renal function test, serum electrolytes, blood culture and toxicology screening if appropriate.
• Consider Antiepileptic Drug (AED) level.
Early Status Epilepticus (Seizure 5-30 minutes):
• IV Lorazepam 0.1 mg/kg (max: 4 mg) slowly over 2-5 minutes. OR
• IV Diazepam 0.2 mg/kg (max: 10 mg) slowly over 2-5 minutes.
If no IV access. consider:
• Buccal Midazolam 0.5 mg/kg (max: 10 mg). OR
• PR Diazepam 0.5 mg/kg (max: 20 mg). OR
• IM Midazolam 0.2 mg/kg (max: 10 mg).
(Do not give more than two doses of Benzodiazepines)
Established Status Epilepticus (Seizure 30-60 minutes):
• IV Phenytoin 20 mg/Kg (max: 1000 mg) infusion over 20 minutes with cardiac monitoring (if not on regular Phenytoin).
If seizure continues:
• IV Phenobarbitone 20 mg/Kg (max: 1000 mg) over 20 minutes.
Alternative medications:-
• IV Levetiracetam 20-60 mg/Kg (max: 2500 mg) over 20 minutes. OR
• IV Valproic acid 20-40 mg/Kg (max: 3000 mg ) over 20 minutes.
Refractory Status Epilepticus (Seizure more than 60 minutes):
• Admit to PICU - Rapid sequence intubation
• IV Midazolam Loading dose 0.15 mg/Kg (max: 8 mg) over 2-3 minutes, followed by continuous infusion of 2 mcg/Kg/minute, titrate to effect up to maximum of 24 mcg/Kg/minute. OR
• IV Thiopental Sodium Loading dose 3 mg/Kg (max: 500 mg/dose) over 10 minutes, followed by continuous IV infusion of 3 mg/Kg/hour, titrate to effect up to maximum of 5 mg/Kg/hour. OR
• IV Pentobarbital Loading dose 5 mg/Kg over 10 minutes, followed by continuous IV infusion of 0.5 mg/Kg/hour, titrate to effect up to maximum of 5 mg/Kg/hour.
- Dr Ahmad khobrani @alkhobrani99
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