A 26-year-old man is brought with ongoing generalized convulsions lasting 12 minutes despite two doses of rectal midazolam given at home. Airway and oxygenation are being supported and glucose is normal. What is the immediate next pharmacological step?
- A Intravenous phenytoin infusion over 20 minutes
- B Oral levetiracetam loading dose
- C Intravenous lorazepam ✓
- D Intravenous magnesium sulfate
Correct answer: C. Intravenous lorazepam
Explanation
Established status epilepticus requires prompt administration of an adequate dose of a benzodiazepine, and intravenous lorazepam is the standard first-line agent, repeatable once after several minutes if seizures persist. Phenytoin or fosphenytoin is the usual second-line therapy after benzodiazepines fail, not before. Oral loading is inappropriate in a convulsing patient. Magnesium sulfate treats eclampsia, not general status epilepticus.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.