STATUS EPILEPTICUS
Persistent seizure >5minutes or recurrent seizures without return to consciousness in 5 minutes
Initial Treatment
- Lorazepam (preferred over diazepam because longer t1/2 of distribution in CNS): 2-4 mg IV every 10-15 minutes (maximum dose 12mg)
- Fosphenytoin: 20 PE/kg IV at a rate of 150 PE/min or Phenytoin: 20 mg/kg at a rate of 50 mg/minute
Refractory Status Epilepticus
Failure to respond to optimal benzodiazepine and phenytoin (or fosphenytoin) loading after 20 minute. Requires intubation and recommend EEG monitoring
- Phenobarbital: 20 mg/kg IV bolus over 50mg/min
- Propofol: Loading dose @ 2 mg/kg bolus followed by drip @ 1 mg/kg/hr (titrate) to goal of seizure cessation
- Midazolam: Loading dose: 0.2 mg/kg bolus (maximum 10mg bolus) followed by drip @ 0.2 mg/kg/hr to goal of seizure cessation
Additional considerations
- Valproic Acid
- Levetiracetam
- Consider hypoglycmia, toxic ingestions (dilantin of little value), eclampsia in the pregnant patient