1st line:

• Lorazepam 0.1mg/kg IV MAX 4mg/dose (max rate 2mg/min). May be given IM but IV preferred. Repeat q10-15 min to max 8mg/12hr.
  • OR
• Diazepam 0.2-0.5mg/kg PR single dose q4-12h PRN

 

2nd line:

• Fosphenytoin 20mg PE/kg IV loading dose (at 100-150 mg PE/minute) then second dose 5-10mg PE/kg if necessary. Time to peak with IV ~ 15 min. May be given IM. Time to peak with IM is 30 min to 3 hours.
  • OR
• Phenytoin 20mg/kg IV loading dose max rate 50mg/min then second dose 5-10mg/kg if necessary. Onset of action 0.5-1 hour. Do NOT give IM due to tissue necrosis effects--use fosphenytoin IM instead.

 

3rd line (move on to 3rd line if patient still seizing after loading dose of 2nd line drug):

• Phenobarbital 20mg/kg IV (max rate 50 mg/min). Maximum dose: 1000 mg. Then second dose as soon as 10 min later: 5-10mg/kg if necessary. Maximum total dose: 40 mg/kg. May be given IM but IV is proper route for status epilepticus. 

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The Compendium platform was created by David Kwinter, MD, CCFP(EM).