Template:Seizure actively seizing management - Revision history

Danbot: Convert to MedicationDose template — single source of truth with SMW; all dosing verified against AES 2016 and ESETT

2026-03-20T15:50:00Z

Convert to MedicationDose template — single source of truth with SMW; all dosing verified against AES 2016 and ESETT

← Older revision		Revision as of 15:50, 20 March 2026
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	===Medications===		===Medications===
	*[[Benzodiazepine]] (Initial treatment of choice)<ref>Glauser T, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16(1):48-61.</ref>		*[[Benzodiazepine]] (Initial treatment of choice)<ref>Glauser T, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16(1):48-61.</ref>
	**[[Midazolam~~]] IM~~ 10 mg (> 40 kg), ~~5mg~~ (13-40 kg), or 0.2 mg/kg<ref>McMullan J, Sasson C, Pancioli A, Silbergleit R: Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med 2010; 17:575-582</ref>		**{{MedicationDose\|drug=Midazolam\|dose=10 mg (>40 kg), 5 mg (13-40 kg), or 0.2 mg/kg\|route=IM\|context=1st line benzodiazepine\|indication=Status epilepticus\|population=Adult}}<ref>McMullan J, Sasson C, Pancioli A, Silbergleit R: Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med 2010; 17:575-582</ref>
	***May also be given IN at 0.2 mg/kg, max 10 mg		***May also be given IN at 0.2 mg/kg, max 10 mg
	***OR buccal at 0.3 mg/kg, max 10 mg		***OR buccal at 0.3 mg/kg, max 10 mg
	**[[Lorazepam~~]] IV 4 mg or~~ 0.1 mg/kg~~; may~~ repeat one dose<ref>Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. doi:10.5698/1535-7597-16.1.48</ref>		**{{MedicationDose\|drug=Lorazepam\|dose=0.1 mg/kg\|route=IV\|context=1st line benzodiazepine\|indication=Status epilepticus\|population=Adult\|max_dose=4 mg\|notes=May repeat one dose}}<ref>Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. doi:10.5698/1535-7597-16.1.48</ref>
	**[[Diazepam~~]] IV~~ 0.15-0.2 mg/kg ~~(up to~~ 10 mg~~); may~~ repeat one dose or PR 0.2-0.5 mg/kg (~~up to~~ 20 mg) once <ref>Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. doi:10.5698/1535-7597-16.1.48</ref>		**{{MedicationDose\|drug=Diazepam\|dose=0.15-0.2 mg/kg\|route=IV\|context=1st line benzodiazepine\|indication=Status epilepticus\|population=Adult\|max_dose=10 mg\|notes=May repeat one dose; or PR 0.2-0.5 mg/kg (max 20 mg) once}}<ref>Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. doi:10.5698/1535-7597-16.1.48</ref>

	*Secondary medications		*Secondary medications
	**ESETT trial<ref>[https://www.nejm.org/doi/10.1056/NEJMoa1905795 Kapur J, Elm J, Chamberlain J, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019;381(22):2103-2113. doi:10.1056/NEJMoa1905795]</ref> compared second line antiseizure medications and they all are equally efficacious. Therefore may be best to use the one with least side effects <ref>[https://emcrit.org/pulmcrit/esett/ PulmCrit- All 2nd line conventional anti-epileptics are equally good… or equally bad?]</ref> which is [[Levetiracetam]]		**ESETT trial<ref>[https://www.nejm.org/doi/10.1056/NEJMoa1905795 Kapur J, Elm J, Chamberlain J, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019;381(22):2103-2113. doi:10.1056/NEJMoa1905795]</ref> compared second line antiseizure medications and they all are equally efficacious. Therefore may be best to use the one with least side effects <ref>[https://emcrit.org/pulmcrit/esett/ PulmCrit- All 2nd line conventional anti-epileptics are equally good… or equally bad?]</ref> which is [[Levetiracetam]]
	**[[Levetiracetam~~]] IV~~ 60 mg/kg~~, max~~ 4500 mg~~/dose,~~ or 1500 mg oral load <span style="color:#008000"> ('''preferred in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>		**{{MedicationDose\|drug=Levetiracetam\|dose=60 mg/kg\|route=IV\|context=2nd line antiepileptic\|indication=Status epilepticus\|population=Adult\|max_dose=4500 mg\|notes=Preferred in pregnancy; or 1500 mg oral load}} <span style="color:#008000"> ('''preferred in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>
	**[[Phenytoin~~]] IV~~ 18 mg/kg at ~~≤ 50~~ mg/min <span style="color:red"> ('''avoid in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>		**{{MedicationDose\|drug=Phenytoin\|dose=18 mg/kg at ≤50 mg/min\|route=IV\|context=2nd line antiepileptic\|indication=Status epilepticus\|population=Adult}} <span style="color:red"> ('''avoid in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>
	**[[Fosphenytoin~~]] IV~~ 20-30 mg/kg at 150 mg/min ~~(may~~ also be given IM)		**{{MedicationDose\|drug=Fosphenytoin\|dose=20-30 mg PE/kg at 150 mg/min\|route=IV\|context=2nd line antiepileptic\|indication=Status epilepticus\|population=Adult\|notes=May also be given IM; avoid in suspected toxicology case}}
	***Contraindicated in pts w/ 2nd or 3rd degree AV block		***Contraindicated in pts w/ 2nd or 3rd degree AV block
	***Avoid phenytoin or fosphenytoin in suspected toxicology case due to sodium channel blockade		**{{MedicationDose\|drug=Valproic acid\|dose=20-40 mg/kg at 5 mg/kg/min\|route=IV\|context=2nd line antiepileptic\|indication=Status epilepticus\|population=Adult\|max_dose=3000 mg}} <span style="color:red"> ('''avoid in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>
	**[[Valproic acid~~]] IV~~ 20-40 mg/kg at 5 mg/kg/min~~, max~~ 3000 mg <span style="color:red"> ('''avoid in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>
	*Refractory medications		*Refractory medications
	**[[Propofol]] 2-~~5mg~~/kg load, then ~~infusion of~~ 30-~~200mcg~~/kg/min ~~(equivalent of 2-10mg/kg/hr) '''OR'''~~		**{{MedicationDose\|drug=Propofol\|dose=2-5 mg/kg load, then 30-200 mcg/kg/min\|route=IV\|context=Refractory status epilepticus\|indication=Status epilepticus\|population=Adult}}
	**[[Midazolam]] 0.~~2mg~~/kg, then ~~infusion of~~ 0.05-~~2mg~~/kg/hr ~~'''OR'''~~		**{{MedicationDose\|drug=Midazolam\|dose=0.2 mg/kg load, then 0.05-2 mg/kg/hr\|route=IV drip\|context=Refractory status epilepticus\|indication=Status epilepticus\|population=Adult}}
	**[[Ketamine~~]] loading~~ dose 0.5 to 3 mg/kg, ~~followed by infusion of~~ 0.3 to 4 mg/kg/hr<ref>Legriel S, Oddo M, and Brophy GM. ~~What’s~~ new in refractory status epilepticus? Intensive Care Medicine. 2016:1-4.</ref>		**{{MedicationDose\|drug=Ketamine\|dose=0.5-3 mg/kg load, then 0.3-4 mg/kg/hr\|route=IV\|context=Refractory status epilepticus\|indication=Status epilepticus\|population=Adult}}<ref>Legriel S, Oddo M, and Brophy GM. What's new in refractory status epilepticus? Intensive Care Medicine. 2016:1-4.</ref>
	**[[Lacosamide~~]] IV~~ 400 mg ~~IV loading dose~~ over 15 min, then ~~maintenance dose of~~ 200 mg ~~q12hrs PO/~~IV<ref>Legros B et al. Intravenous lacosamide in refractory seizure clusters and status epilepticus: comparison of 200 and 400 mg loading doses. Neurocrit Care. 2014 Jun;20(3):484-8.</ref>		**{{MedicationDose\|drug=Lacosamide\|dose=400 mg load over 15 min, then 200 mg q12hr\|route=IV\|context=Refractory status epilepticus\|indication=Status epilepticus\|population=Adult}}<ref>Legros B et al. Intravenous lacosamide in refractory seizure clusters and status epilepticus: comparison of 200 and 400 mg loading doses. Neurocrit Care. 2014 Jun;20(3):484-8.</ref>
	**[[Phenobarbital~~]] IV~~ 15-20 mg/kg at 50-75 mg/min<ref>Pugin D et al. Is pentobarbital safe and efficacious in the treatment of super-refractory status epilepticus: a cohort study. Critical Care 2014. DOI: 10.1186/cc13883.</ref>		**{{MedicationDose\|drug=Phenobarbital\|dose=15-20 mg/kg at 50-75 mg/min\|route=IV\|context=Refractory status epilepticus\|indication=Status epilepticus\|population=Adult\|notes=Then 0.5-4 mg/kg/hr drip; titrate to suppression-burst on EEG}}<ref>Pugin D et al. Is pentobarbital safe and efficacious in the treatment of super-refractory status epilepticus: a cohort study. Critical Care 2014. DOI: 10.1186/cc13883.</ref>
	***Then continuous infusion at 0.5-4.0 mg/kg/hr
	***Dose adjusted to suppression-burst pattern on continuous EEG
	**Consider consulting anesthesia for inhaled anesthetics (potent anticonvulsants)<ref>Mirsattari SM et al. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004 Aug;61(8):1254-9.</ref>		**Consider consulting anesthesia for inhaled anesthetics (potent anticonvulsants)<ref>Mirsattari SM et al. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004 Aug;61(8):1254-9.</ref>

	*Others		*Others
	**[[Carbamazepine]] 8 mg/kg ~~oral suspension,~~ single oral load		**{{MedicationDose\|drug=Carbamazepine\|dose=8 mg/kg single oral load\|route=PO\|context=Adjunct antiepileptic\|indication=Status epilepticus\|population=Adult}}
	**[[Gabapentin]] 900 mg/day ~~oral at~~ 300 mg ~~tid~~ for 3 days		**{{MedicationDose\|drug=Gabapentin\|dose=900 mg/day (300 mg TID for 3 days)\|route=PO\|context=Adjunct antiepileptic\|indication=Status epilepticus\|population=Adult}}
	**[[Lamotrigine]] 6.5 mg/kg single oral load		**{{MedicationDose\|drug=Lamotrigine\|dose=6.5 mg/kg single oral load\|route=PO\|context=Adjunct antiepileptic\|indication=Status epilepticus\|population=Adult}}

	===Other Considerations===		===Other Considerations===
	*Secondary causes of seizure (e.g. [[hyponatremia]], [[hypoglycemia]], [[INH toxicity]], [[ecclampsia]])		*Secondary causes of seizure (e.g. [[hyponatremia]], [[hypoglycemia]], [[INH toxicity]], [[ecclampsia]])
	*Nonconvulsive seizures or [[status epilepticus]] - get EEG		*Nonconvulsive seizures or [[status epilepticus]] - get EEG

Zbuchwald: /* Medications */

2025-10-05T09:08:51Z

Medications

← Older revision		Revision as of 09:08, 5 October 2025
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	**[[Valproic acid]] IV 20-40 mg/kg at 5 mg/kg/min, max 3000 mg <span style="color:red"> ('''avoid in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>		**[[Valproic acid]] IV 20-40 mg/kg at 5 mg/kg/min, max 3000 mg <span style="color:red"> ('''avoid in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>
	*Refractory medications		*Refractory medications
	**[[Propofol]] 2-5mg/kg load, then infusion of 30-~~300mcg~~/kg/min (equivalent of 2-10mg/kg/hr) '''OR'''		**[[Propofol]] 2-5mg/kg load, then infusion of 30-200mcg/kg/min (equivalent of 2-10mg/kg/hr) '''OR'''
	**[[Midazolam]] 0.2mg/kg, then infusion of 0.05-2mg/kg/hr '''OR'''		**[[Midazolam]] 0.2mg/kg, then infusion of 0.05-2mg/kg/hr '''OR'''
	**[[Ketamine]] loading dose 0.5 to 3 mg/kg, followed by infusion of 0.3 to 4 mg/kg/hr<ref>Legriel S, Oddo M, and Brophy GM. What’s new in refractory status epilepticus? Intensive Care Medicine. 2016:1-4.</ref>		**[[Ketamine]] loading dose 0.5 to 3 mg/kg, followed by infusion of 0.3 to 4 mg/kg/hr<ref>Legriel S, Oddo M, and Brophy GM. What’s new in refractory status epilepticus? Intensive Care Medicine. 2016:1-4.</ref>

Zbuchwald: /* Medications */

2025-10-05T09:08:21Z

Medications

← Older revision		Revision as of 09:08, 5 October 2025
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	**[[Valproic acid]] IV 20-40 mg/kg at 5 mg/kg/min, max 3000 mg <span style="color:red"> ('''avoid in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>		**[[Valproic acid]] IV 20-40 mg/kg at 5 mg/kg/min, max 3000 mg <span style="color:red"> ('''avoid in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>
	*Refractory medications		*Refractory medications
	**[[Propofol]] 2-5mg/kg, then infusion of 2-10mg/kg/hr '''OR'''		**[[Propofol]] 2-5mg/kg load, then infusion of 30-300mcg/kg/min (equivalent of 2-10mg/kg/hr) '''OR'''
	**[[Midazolam]] 0.2mg/kg, then infusion of 0.05-2mg/kg/hr '''OR'''		**[[Midazolam]] 0.2mg/kg, then infusion of 0.05-2mg/kg/hr '''OR'''
	**[[Ketamine]] loading dose 0.5 to 3 mg/kg, followed by infusion of 0.3 to 4 mg/kg/hr<ref>Legriel S, Oddo M, and Brophy GM. What’s new in refractory status epilepticus? Intensive Care Medicine. 2016:1-4.</ref>		**[[Ketamine]] loading dose 0.5 to 3 mg/kg, followed by infusion of 0.3 to 4 mg/kg/hr<ref>Legriel S, Oddo M, and Brophy GM. What’s new in refractory status epilepticus? Intensive Care Medicine. 2016:1-4.</ref>

Corkeith: /* Medications */

2021-10-21T00:19:49Z

Medications

← Older revision		Revision as of 00:19, 21 October 2021
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	*Secondary medications		*Secondary medications
	**ESETT trial<ref>[https://www.nejm.org/doi/10.1056/NEJMoa1905795 Kapur J, Elm J, Chamberlain J, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019;381(22):2103-2113. doi:10.1056/NEJMoa1905795]</ref> compared second line antiseizure medications and they all are equally efficacious. Therefore may be best to use the one with least side effects <ref>[https://emcrit.org/pulmcrit/esett/ PulmCrit- All 2nd line conventional anti-epileptics are equally good… or equally bad?]</ref> which is [[Levetiracetam]]		**ESETT trial<ref>[https://www.nejm.org/doi/10.1056/NEJMoa1905795 Kapur J, Elm J, Chamberlain J, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019;381(22):2103-2113. doi:10.1056/NEJMoa1905795]</ref> compared second line antiseizure medications and they all are equally efficacious. Therefore may be best to use the one with least side effects <ref>[https://emcrit.org/pulmcrit/esett/ PulmCrit- All 2nd line conventional anti-epileptics are equally good… or equally bad?]</ref> which is [[Levetiracetam]]
	**[[Levetiracetam]] IV 60 mg/kg, max 4500 mg/dose, or 1500 mg oral load (preferred in pregnancy)		**[[Levetiracetam]] IV 60 mg/kg, max 4500 mg/dose, or 1500 mg oral load <span style="color:#008000"> ('''preferred in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>
	**[[Phenytoin]] IV 18 mg/kg at ≤ 50 mg/min		**[[Phenytoin]] IV 18 mg/kg at ≤ 50 mg/min <span style="color:red"> ('''avoid in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>
	**[[Fosphenytoin]] IV 20-30 mg/kg at 150 mg/min (may also be given IM)		**[[Fosphenytoin]] IV 20-30 mg/kg at 150 mg/min (may also be given IM)
	***Contraindicated in pts w/ 2nd or 3rd degree AV block		***Contraindicated in pts w/ 2nd or 3rd degree AV block
	***Avoid phenytoin or fosphenytoin in suspected toxicology case due to sodium channel blockade		***Avoid phenytoin or fosphenytoin in suspected toxicology case due to sodium channel blockade
	**[[Valproic acid]] IV 20-40 mg/kg at 5 mg/kg/min, max 3000 mg (avoid in pregnancy)		**[[Valproic acid]] IV 20-40 mg/kg at 5 mg/kg/min, max 3000 mg <span style="color:red"> ('''avoid in pregnancy''')</span><ref>Macri E, Greene-Chandos D. Neurological Emergencies During Pregnancy. Neurol Clin. 2021 May;39(2):649-670. doi: 10.1016/j.ncl.2021.02.008. PMID: 33896537</ref>
	*Refractory medications		*Refractory medications
	**[[Propofol]] 2-5mg/kg, then infusion of 2-10mg/kg/hr '''OR'''		**[[Propofol]] 2-5mg/kg, then infusion of 2-10mg/kg/hr '''OR'''

Elcatracho: /* Medications */

2021-01-04T18:13:17Z

Medications

← Older revision		Revision as of 18:13, 4 January 2021
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	**[[Diazepam]] IV 0.15-0.2 mg/kg (up to 10 mg); may repeat one dose or PR 0.2-0.5 mg/kg (up to 20 mg) once <ref>Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. doi:10.5698/1535-7597-16.1.48</ref>		**[[Diazepam]] IV 0.15-0.2 mg/kg (up to 10 mg); may repeat one dose or PR 0.2-0.5 mg/kg (up to 20 mg) once <ref>Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. doi:10.5698/1535-7597-16.1.48</ref>
	*Secondary medications		*Secondary medications
	**ESETT trial<ref>[https://www.nejm.org/doi/10.1056/NEJMoa1905795 Kapur J, Elm J, Chamberlain J, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019;381(22):2103-2113. doi:10.1056/NEJMoa1905795]</ref> compared second line antiseizure medications and they all are equally efficacious. ~~Therefor~~ may be best to use the one with least side effects <ref>[https://emcrit.org/pulmcrit/esett/ PulmCrit- All 2nd line conventional anti-epileptics are equally good… or equally bad?]</ref> which is [[Levetiracetam]]		**ESETT trial<ref>[https://www.nejm.org/doi/10.1056/NEJMoa1905795 Kapur J, Elm J, Chamberlain J, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019;381(22):2103-2113. doi:10.1056/NEJMoa1905795]</ref> compared second line antiseizure medications and they all are equally efficacious. Therefore may be best to use the one with least side effects <ref>[https://emcrit.org/pulmcrit/esett/ PulmCrit- All 2nd line conventional anti-epileptics are equally good… or equally bad?]</ref> which is [[Levetiracetam]]
	**[[Levetiracetam]] IV 60 mg/kg, max 4500 mg/dose, or 1500 mg oral load (preferred in pregnancy)		**[[Levetiracetam]] IV 60 mg/kg, max 4500 mg/dose, or 1500 mg oral load (preferred in pregnancy)
	**[[Phenytoin]] IV 18 mg/kg at ≤ 50 mg/min		**[[Phenytoin]] IV 18 mg/kg at ≤ 50 mg/min

Elcatracho: /* Medications */

2020-12-10T20:18:40Z

Medications

← Older revision		Revision as of 20:18, 10 December 2020
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	***May also be given IN at 0.2 mg/kg, max 10 mg		***May also be given IN at 0.2 mg/kg, max 10 mg
	***OR buccal at 0.3 mg/kg, max 10 mg		***OR buccal at 0.3 mg/kg, max 10 mg
	**[[Lorazepam]] IV 2-4 mg or 0.1 mg/kg		**[[Lorazepam]] IV 4 mg or 0.1 mg/kg; may repeat one dose<ref>Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. doi:10.5698/1535-7597-16.1.48</ref>
	**[[Diazepam]] IV 0.15-0.2 mg/kg (up to 10 mg) or PR 0.2-0.5 mg/kg (up to 20 mg)		**[[Diazepam]] IV 0.15-0.2 mg/kg (up to 10 mg); may repeat one dose or PR 0.2-0.5 mg/kg (up to 20 mg) once <ref>Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. doi:10.5698/1535-7597-16.1.48</ref>
	*Secondary medications		*Secondary medications
	**ESETT trial<ref>[https://www.nejm.org/doi/10.1056/NEJMoa1905795 Kapur J, Elm J, Chamberlain J, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019;381(22):2103-2113. doi:10.1056/NEJMoa1905795]</ref> compared second line antiseizure medications and they all are equally efficacious. Therefor may be best to use the one with least side effects <ref>[https://emcrit.org/pulmcrit/esett/ PulmCrit- All 2nd line conventional anti-epileptics are equally good… or equally bad?]</ref> which is [[Levetiracetam]]		**ESETT trial<ref>[https://www.nejm.org/doi/10.1056/NEJMoa1905795 Kapur J, Elm J, Chamberlain J, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019;381(22):2103-2113. doi:10.1056/NEJMoa1905795]</ref> compared second line antiseizure medications and they all are equally efficacious. Therefor may be best to use the one with least side effects <ref>[https://emcrit.org/pulmcrit/esett/ PulmCrit- All 2nd line conventional anti-epileptics are equally good… or equally bad?]</ref> which is [[Levetiracetam]]

Kxl328: /* Medications */

2020-02-15T08:54:26Z

Medications

← Older revision		Revision as of 08:54, 15 February 2020
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	***Contraindicated in pts w/ 2nd or 3rd degree AV block		***Contraindicated in pts w/ 2nd or 3rd degree AV block
	***Avoid phenytoin or fosphenytoin in suspected toxicology case due to sodium channel blockade		***Avoid phenytoin or fosphenytoin in suspected toxicology case due to sodium channel blockade
	**[[Valproic acid]] IV 20-40 mg/kg at 5 mg/kg/min (avoid in pregnancy)		**[[Valproic acid]] IV 20-40 mg/kg at 5 mg/kg/min, max 3000 mg (avoid in pregnancy)
	*Refractory medications		*Refractory medications
	**[[Propofol]] 2-5mg/kg, then infusion of 2-10mg/kg/hr '''OR'''		**[[Propofol]] 2-5mg/kg, then infusion of 2-10mg/kg/hr '''OR'''

Kxl328: /* Medications */

2020-02-15T08:53:55Z

Medications

← Older revision		Revision as of 08:53, 15 February 2020
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	**[[Fosphenytoin]] IV 20-30 mg/kg at 150 mg/min (may also be given IM)		**[[Fosphenytoin]] IV 20-30 mg/kg at 150 mg/min (may also be given IM)
	***Contraindicated in pts w/ 2nd or 3rd degree AV block		***Contraindicated in pts w/ 2nd or 3rd degree AV block
	***Avoid phenytoin or fosphenytoin in suspected toxicology case		***Avoid phenytoin or fosphenytoin in suspected toxicology case due to sodium channel blockade
	**[[Valproic acid]] IV 20-40 mg/kg at 5 mg/kg/min (avoid in pregnancy)		**[[Valproic acid]] IV 20-40 mg/kg at 5 mg/kg/min (avoid in pregnancy)
	*Refractory medications		*Refractory medications

Kxl328: /* Medications */

2020-02-15T08:52:58Z

Medications

← Older revision		Revision as of 08:52, 15 February 2020
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	===Medications===		===Medications===
	*[[Benzodiazepine]] (Initial treatment of choice)<ref>Glauser T, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16(1):48-61.</ref>		*[[Benzodiazepine]] (Initial treatment of choice)<ref>Glauser T, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16(1):48-61.</ref>
	**[[Midazolam]] IM 10 mg (> 40 kg), 5mg (13-40 kg), or 0.2 mg/kg<ref>McMullan J, Sasson C, Pancioli A, Silbergleit R: Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med 2010; 17:575-582</ref> ~~- may~~ also be given IN		**[[Midazolam]] IM 10 mg (> 40 kg), 5mg (13-40 kg), or 0.2 mg/kg<ref>McMullan J, Sasson C, Pancioli A, Silbergleit R: Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med 2010; 17:575-582</ref>
			***May also be given IN at 0.2 mg/kg, max 10 mg
			***OR buccal at 0.3 mg/kg, max 10 mg
	**[[Lorazepam]] IV 2-4 mg or 0.1 mg/kg		**[[Lorazepam]] IV 2-4 mg or 0.1 mg/kg
	**[[Diazepam]] IV 0.15-0.2 mg/kg (up to 10 mg) or PR 0.2-0.5 mg/kg (up to 20 mg)		**[[Diazepam]] IV 0.15-0.2 mg/kg (up to 10 mg) or PR 0.2-0.5 mg/kg (up to 20 mg)

Kxl328: /* Medications */

2020-02-15T08:51:27Z

Medications

← Older revision		Revision as of 08:51, 15 February 2020
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	*[[Benzodiazepine]] (Initial treatment of choice)<ref>Glauser T, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16(1):48-61.</ref>		*[[Benzodiazepine]] (Initial treatment of choice)<ref>Glauser T, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16(1):48-61.</ref>
	**[[Midazolam]] IM 10 mg (> 40 kg), 5mg (13-40 kg), or 0.2 mg/kg<ref>McMullan J, Sasson C, Pancioli A, Silbergleit R: Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med 2010; 17:575-582</ref> - may also be given IN		**[[Midazolam]] IM 10 mg (> 40 kg), 5mg (13-40 kg), or 0.2 mg/kg<ref>McMullan J, Sasson C, Pancioli A, Silbergleit R: Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med 2010; 17:575-582</ref> - may also be given IN
	**[[Lorazepam]] IV 2 mg or 0.1 mg/kg		**[[Lorazepam]] IV 2-4 mg or 0.1 mg/kg
	**[[Diazepam]] IV 0.15-0.2 mg/kg (up to 10 mg) or PR 0.2-0.5 mg/kg (up to 20 mg)		**[[Diazepam]] IV 0.15-0.2 mg/kg (up to 10 mg) or PR 0.2-0.5 mg/kg (up to 20 mg)
	*Secondary medications		*Secondary medications