A 24-year-old woman presents with generalised tonic-clonic seizures for the past 20 minutes without regaining consciousness between them. Intravenous access has been secured. What is the correct first-line pharmacological intervention?

• A Intramuscular phenobarbitone 10 mg/kg
• B Intravenous fosphenytoin 20 mg PE/kg
• C Intravenous propofol infusion
• D Intravenous lorazepam 0.1 mg/kg ✓

Explanation

Generalised convulsive status epilepticus is treated first with a benzodiazepine, and intravenous lorazepam 0.1 mg/kg is the standard first-line agent because of its long duration of action within the brain. Fosphenytoin is second-line therapy given after the benzodiazepine to prevent recurrence. Propofol is reserved for refractory status requiring anaesthesia, and intramuscular phenobarbitone is not preferred when intravenous access is available.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.