Template:Initial management of pediatric status epilepticus - Revision history

Ostermayer: Marked this version for translation

2026-01-02T14:04:05Z

Marked this version for translation

← Older revision		Revision as of 14:04, 2 January 2026
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	<translate>		<translate>

	===Initial management of [[Special:MyLanguage/pediatric status epilepticus\|pediatric status epilepticus]]===		===Initial management of [[Special:MyLanguage/pediatric status epilepticus\|pediatric status epilepticus]]=== <!--T:1-->

			<!--T:2-->
	{\| {{table}}		{\| {{table}}
	\| align="center" style="background:#f0f0f0;"\|'''Timeline'''		\| align="center" style="background:#f0f0f0;"\|'''Timeline'''

Ostermayer: Prepared the page for translation

2026-01-02T14:03:28Z

Prepared the page for translation

← Older revision		Revision as of 14:03, 2 January 2026
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	===Initial management of [[pediatric status epilepticus]]===		<languages/>
			<translate>

			===Initial management of [[Special:MyLanguage/pediatric status epilepticus\|pediatric status epilepticus]]===

	{\| {{table}}		{\| {{table}}
	\| align="center" style="background:#f0f0f0;"\|'''Timeline'''		\| align="center" style="background:#f0f0f0;"\|'''Timeline'''
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	** ABC's		** ABC's
	** Maintain airway; suction, jaw thrust		** Maintain airway; suction, jaw thrust
	** Provide [[O2]] via positive pressure ventilation with BVM/Mapleson		** Provide [[Special:MyLanguage/O2\|O2]] via positive pressure ventilation with BVM/Mapleson
	***Likely apneic/hypoventilating/hypercapneic		***Likely apneic/hypoventilating/hypercapneic
	***Only apply CPAP or a non-rebreather if patient stops seizing and has adequate chest rise		***Only apply CPAP or a non-rebreather if patient stops seizing and has adequate chest rise
	*Establish IV/[[IO]] access		*Establish IV/[[Special:MyLanguage/IO\|IO]] access
	*Check blood glucose		*Check blood glucose
	*If fever, [[acetaminophen]] 15 mg/kg rectally		*If fever, [[Special:MyLanguage/acetaminophen\|acetaminophen]] 15 mg/kg rectally
	\|\|		\|\|
	*'''Benzodiazepine: first dose'''		*'''Benzodiazepine: first dose'''
	**IV/IO access established		**IV/IO access established
	***[[Lorazepam]] 0.1 mg/kg IV (max 4 mg) if IV/IO access, OR		***[[Special:MyLanguage/Lorazepam\|Lorazepam]] 0.1 mg/kg IV (max 4 mg) if IV/IO access, OR
	***[[Diazepam]] 0.2 mg/kg IM (max 10 mg) if no access		***[[Special:MyLanguage/Diazepam\|Diazepam]] 0.2 mg/kg IM (max 10 mg) if no access
	**IV or IO access not achieved within 3 minutes:		**IV or IO access not achieved within 3 minutes:
	***Buccal [[midazolam]] 0.2 mg/kg (max 10 mg), OR		***Buccal [[Special:MyLanguage/midazolam\|midazolam]] 0.2 mg/kg (max 10 mg), OR
	***IM [[midazolam]] 0.2 mg/kg (max 10 mg), OR		***IM [[Special:MyLanguage/midazolam\|midazolam]] 0.2 mg/kg (max 10 mg), OR
	***Rectal [[diazepam]] (Diastat gel or injection solution given rectally) 0.5 mg/kg (max 20 mg)		***Rectal [[Special:MyLanguage/diazepam\|diazepam]] (Diastat gel or injection solution given rectally) 0.5 mg/kg (max 20 mg)
	\|-		\|-
	\| 5-10 minutes		\| 5-10 minutes
	\|\|		\|\|
	*Give antibiotics if concern for [[sepsis]] or [[meningitis]]		*Give antibiotics if concern for [[Special:MyLanguage/sepsis\|sepsis]] or [[Special:MyLanguage/meningitis\|meningitis]]
	*POC electrolytes, if available		*POC electrolytes, if available
	\|\|		\|\|
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	\|\|		\|\|
	*'''Antiepileptic: first therapy'''		*'''Antiepileptic: first therapy'''
	**[[Levetiracetam]] 60 mg/kg IV/IO (max 4500mg) over 5 min, OR		**[[Special:MyLanguage/Levetiracetam\|Levetiracetam]] 60 mg/kg IV/IO (max 4500mg) over 5 min, OR
	**[[Fosphenytoin]]^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR		**[[Special:MyLanguage/Fosphenytoin\|Fosphenytoin]]^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR
	**[[Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR		**[[Special:MyLanguage/Valproate\|Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR
	**[[Phenobarbital]] 20 mg/kg IV/IO, (max 1 g) over 20 min, (expect respiratory depression with apnea)¥		**[[Special:MyLanguage/Phenobarbital\|Phenobarbital]] 20 mg/kg IV/IO, (max 1 g) over 20 min, (expect respiratory depression with apnea)¥
	\|-		\|-
	\| 15-30 minutes		\| 15-30 minutes
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	\|\|		\|\|
	*'''Antiepileptic: second therapy''' (if medication not already given)		*'''Antiepileptic: second therapy''' (if medication not already given)
	**[[Fosphenytoin]]^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR		**[[Special:MyLanguage/Fosphenytoin\|Fosphenytoin]]^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR
	**[[Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR		**[[Special:MyLanguage/Valproate\|Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR
	**[[Phenobarbital]] 20 mg/kg IV/IO (max 1 g) over 20 min		**[[Special:MyLanguage/Phenobarbital\|Phenobarbital]] 20 mg/kg IV/IO (max 1 g) over 20 min
	***10 mg/kg if phenobarbital already given, OR		***10 mg/kg if phenobarbital already given, OR
	**[[Levetiracetam]] 60 mg/kg IV/IO (max 4500mg) over 5 min		**[[Special:MyLanguage/Levetiracetam\|Levetiracetam]] 60 mg/kg IV/IO (max 4500mg) over 5 min
	*If [[isoniazid toxicity]] suspected, [[pyridoxine]]		*If [[Special:MyLanguage/isoniazid toxicity\|isoniazid toxicity]] suspected, [[Special:MyLanguage/pyridoxine\|pyridoxine]]
	**Infants (<1 year): 100 mg IV or IO in		**Infants (<1 year): 100 mg IV or IO in
	**Otherwise 70 mg/kg IV or IO (max = 5 g)		**Otherwise 70 mg/kg IV or IO (max = 5 g)
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	**Increase infusion rate by 0.2mg/kg/hr (max 10mg/hr) every 10 minutes until burst suppression or max dose of 2mg/kg/hr (max 100mg/hr)		**Increase infusion rate by 0.2mg/kg/hr (max 10mg/hr) every 10 minutes until burst suppression or max dose of 2mg/kg/hr (max 100mg/hr)
	\|}		\|}
	^May be ineffective for toxin-induced seizures and contraindicated in [[cocaine toxicity]]		^May be ineffective for toxin-induced seizures and contraindicated in [[Special:MyLanguage/cocaine toxicity\|cocaine toxicity]]
			</translate>

Cdichang: /* Initial management of pediatric status epilepticus */

2022-12-13T15:59:02Z

Initial management of pediatric status epilepticus

← Older revision		Revision as of 15:59, 13 December 2022
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	** ABC's		** ABC's
	** Maintain airway; suction, jaw thrust		** Maintain airway; suction, jaw thrust
	** Provide [[O2]] via positive pressure ventilation with BVM/Mapleson~~, likely~~ apneic/hypoventilating/hypercapneic		** Provide [[O2]] via positive pressure ventilation with BVM/Mapleson
	***Only apply CPAP or ~~use~~ a ~~Non~~-rebreather if patient stops seizing and has adequate chest rise ~~on their own~~		***Likely apneic/hypoventilating/hypercapneic
			***Only apply CPAP or a non-rebreather if patient stops seizing and has adequate chest rise
	*Establish IV/[[IO]] access		*Establish IV/[[IO]] access
	*Check blood glucose		*Check blood glucose
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	\|\|		\|\|
	*Consider intubation, if not already performed		*Consider intubation, if not already performed
			**Consider NG tube to decompress stomach prior to intubation
	*Pediatric neurology consultation		*Pediatric neurology consultation
	\|\|		\|\|
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	*If [[isoniazid toxicity]] suspected, [[pyridoxine]]		*If [[isoniazid toxicity]] suspected, [[pyridoxine]]
	**Infants (<1 year): 100 mg IV or IO in		**Infants (<1 year): 100 mg IV or IO in
	**Otherwise 70 mg/kg IV or IO (max = 5 g)		**Otherwise 70 mg/kg IV or IO (max = 5 g)
			\|-
			\| >30 minutes
			\|\|
			*Intubate patient, if not already performed
			*Consult referral site / PICU for admission and continuous EEG
			\|\|
			*'''Antiepileptic: third therapy'''
			**Midazolam 0.2mg/kg IV bolus (max 10mg), followed by 0.2mg/kg/hr (max 10mg/hr) infusion drip
			**Increase infusion rate by 0.2mg/kg/hr (max 10mg/hr) every 10 minutes until burst suppression or max dose of 2mg/kg/hr (max 100mg/hr)
	\|}		\|}
	^May be ineffective for toxin-induced seizures and contraindicated in [[cocaine toxicity]]		^May be ineffective for toxin-induced seizures and contraindicated in [[cocaine toxicity]]

Cdichang: /* Initial management of pediatric status epilepticus */

2022-12-13T15:49:30Z

Initial management of pediatric status epilepticus

← Older revision		Revision as of 15:49, 13 December 2022
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	** ABC's		** ABC's
	** Maintain airway; suction, jaw thrust		** Maintain airway; suction, jaw thrust
	** Provide [[O2]] via ~~CPAP/PPV~~ with BVM/Mapleson, ~~will~~ likely be apneic/hypoventilating		** Provide [[O2]] via positive pressure ventilation with BVM/Mapleson, likely apneic/hypoventilating/hypercapneic
			***Only apply CPAP or use a Non-rebreather if patient stops seizing and has adequate chest rise on their own
	*Establish IV/[[IO]] access		*Establish IV/[[IO]] access
	*Check blood glucose		*Check blood glucose

Cdichang: /* Initial management of pediatric status epilepticus */

2022-12-13T15:41:11Z

Initial management of pediatric status epilepticus

← Older revision		Revision as of 15:41, 13 December 2022
Line 10:		Line 10:
	** ABC's		** ABC's
	** Maintain airway; suction, jaw thrust		** Maintain airway; suction, jaw thrust
	** Provide [[O2]] via CPAP/PPV with BVM/Mapleson if apneic/hypoventilating		** Provide [[O2]] via CPAP/PPV with BVM/Mapleson, will likely be apneic/hypoventilating
	***Only use a non-rebreather mask 10-15 L/min if patient is ventilating on their own with visible chest rise
	*Establish IV/[[IO]] access		*Establish IV/[[IO]] access
	*Check blood glucose		*Check blood glucose
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	*All equally efficacious for status epilepticus		*All equally efficacious for status epilepticus
	*Levetiracetam is preferred given quick administration, favorable side effect profile, and less drug interactions		*Levetiracetam is preferred given quick administration, favorable side effect profile, and less drug interactions
			*Do not combine Phenytoin and Fosphenytoin
	\|\|		\|\|
	*'''Antiepileptic: first therapy'''		*'''Antiepileptic: first therapy'''

Cdichang: /* Initial management of pediatric status epilepticus */

2022-12-13T15:38:08Z

Initial management of pediatric status epilepticus

← Older revision		Revision as of 15:38, 13 December 2022
Line 10:		Line 10:
	** ABC's		** ABC's
	** Maintain airway; suction, jaw thrust		** Maintain airway; suction, jaw thrust
	** Provide [[O2]] via non-rebreather mask 10-15 L/min		** Provide [[O2]] via CPAP/PPV with BVM/Mapleson if apneic/hypoventilating
	***BVM if ~~apneic/hypoventilating~~		***Only use a non-rebreather mask 10-15 L/min if patient is ventilating on their own with visible chest rise
	*Establish IV/[[IO]] access		*Establish IV/[[IO]] access
	*Check blood glucose		*Check blood glucose
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	\| 10-15 minutes		\| 10-15 minutes
	\|\|		\|\|
			*All equally efficacious for status epilepticus
			*Levetiracetam is preferred given quick administration, favorable side effect profile, and less drug interactions
	\|\|		\|\|
	*'''Antiepileptic: first therapy'''		*'''Antiepileptic: first therapy'''

Rossdonaldson1: /* Initial management of pediatric status epilepticus */

2022-12-07T19:51:31Z

Initial management of pediatric status epilepticus

← Older revision		Revision as of 19:51, 7 December 2022
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	*Pediatric neurology consultation		*Pediatric neurology consultation
	\|\|		\|\|
	*'''Antiepileptic: second therapy''' if not already given		*'''Antiepileptic: second therapy''' (if medication not already given)
	**[[Fosphenytoin]]^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR		**[[Fosphenytoin]]^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR
	**[[Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR		**[[Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR

Cdichang: /* Initial management of pediatric status epilepticus */

2022-11-21T18:27:03Z

Initial management of pediatric status epilepticus

← Older revision		Revision as of 18:27, 21 November 2022
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	**[[Fosphenytoin]]^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR		**[[Fosphenytoin]]^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR
	**[[Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR		**[[Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR
	**[[Phenobarbital]] 20 mg/kg IV/IO (max 1 g) over 20 min (10 mg/kg if phenobarbital already given), OR		**[[Phenobarbital]] 20 mg/kg IV/IO (max 1 g) over 20 min
			***10 mg/kg if phenobarbital already given, OR
	**[[Levetiracetam]] 60 mg/kg IV/IO (max 4500mg) over 5 min		**[[Levetiracetam]] 60 mg/kg IV/IO (max 4500mg) over 5 min
	*If [[isoniazid toxicity]] suspected, [[pyridoxine]]		*If [[isoniazid toxicity]] suspected, [[pyridoxine]]

Cdichang: /* Initial management of pediatric status epilepticus */

2022-11-21T18:25:54Z

Initial management of pediatric status epilepticus

← Older revision		Revision as of 18:25, 21 November 2022
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	*'''Antiepileptic: first therapy'''		*'''Antiepileptic: first therapy'''
	**[[Levetiracetam]] 60 mg/kg IV/IO (max 4500mg) over 5 min, OR		**[[Levetiracetam]] 60 mg/kg IV/IO (max 4500mg) over 5 min, OR
	**[[Fosphenytoin]]^ 20 mg PE/ kg IV/IO (max 1500mg) over 10 min, OR		**[[Fosphenytoin]]^ 20 mg PE/kg IV/IO (max 1500mg) over 10 min, OR
	**[[Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR		**[[Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR
	**[[Phenobarbital]] 20 mg/kg IV/IO, (max 1 g) over 20 min, (expect respiratory depression with apnea)¥		**[[Phenobarbital]] 20 mg/kg IV/IO, (max 1 g) over 20 min, (expect respiratory depression with apnea)¥
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	**[[Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR		**[[Valproate]] 40 mg/kg IV/IO (max 3000mg) over 10 min, OR
	**[[Phenobarbital]] 20 mg/kg IV/IO (max 1 g) over 20 min (10 mg/kg if phenobarbital already given), OR		**[[Phenobarbital]] 20 mg/kg IV/IO (max 1 g) over 20 min (10 mg/kg if phenobarbital already given), OR
	**[[Levetiracetam]] 60 mg/kg IV/IO (max 4500mg) over 5 min,		**[[Levetiracetam]] 60 mg/kg IV/IO (max 4500mg) over 5 min
	*If [[isoniazid toxicity]] suspected, [[pyridoxine]]		*If [[isoniazid toxicity]] suspected, [[pyridoxine]]
	**Infants (<1 year): 100 mg IV or IO in		**Infants (<1 year): 100 mg IV or IO in

Cdichang: /* Initial management of pediatric status epilepticus */

2022-11-21T18:24:50Z

Initial management of pediatric status epilepticus

← Older revision		Revision as of 18:24, 21 November 2022
Line 10:		Line 10:
	** ABC's		** ABC's
	** Maintain airway; suction, jaw thrust		** Maintain airway; suction, jaw thrust
	** Provide [[O2]] via non-rebreather mask, 10-15 L/min or BVM if apneic/hypoventilating		** Provide [[O2]] via non-rebreather mask 10-15 L/min
			***BVM if apneic/hypoventilating
	*Establish IV/[[IO]] access		*Establish IV/[[IO]] access
	*Check blood glucose		*Check blood glucose