This patient has status epilepticus (SE), which is traditionally defined as a single seizure or series of seizures lasting 30 minutes or more in which the patient fails to regain consciousness between the seizures. Any seizure lasting more than 5 minutes is unlikely to stop on its own, and treatment should be initiated immediately. The initial care of a patient in SE includes airway assessment, establishing an intravenous line, monitoring hemodynamic status, aggressive supportive care, and assessing and treating any underlying metabolic, toxic, and infectious etiologies. Benzodiazepines (eg, lorazepam) are first-line therapy for SE because they are widely available, can be administered quickly, have rapid onset of action in the central nervous system, and have proven efficacy for SE. Phenytoin is recommended when a benzodiazepine fails to stop SE, and the recommended starting dose is 20 mg/kg IV at a maximal rate of 50 mg/min.1 Calculating the appropriate dose is important because a standard loading dose of phenytoin (ie, 1000 mg or 14.3 mg/kg for an adult weighing 70 kg) is often inadequate and may prolong seizure and increase the risk of morbidity and mortality. Phenobarbital is typically used after benzodiazepines and phenytoin fail to relieve SE.
- Lorazepam 0.1 mg/kg IV.
1. Lowenstein DH, Alldredge BK. Status epilepticus. N Engl J Med 1998;338:970–6.
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