In acute symptomatic convulsive status epilepticus persisting beyond 5 minutes, what is the correct first-line parenteral therapy and its standard adult dose?
- A IV phenytoin 20 mg/kg infused over 5 minutes
- B IV lorazepam 0.1 mg/kg, maximum 4 mg per dose ✓
- C IV valproate 40 mg/kg bolus
- D IM midazolam 0.5 mg/kg repeated every 10 minutes until seizures stop
Correct answer: B. IV lorazepam 0.1 mg/kg, maximum 4 mg per dose
Explanation
Guidelines uniformly recommend a benzodiazepine as first-line therapy for established status epilepticus, with IV lorazepam 0.1 mg/kg up to 4 mg per dose as the reference regimen. Phenytoin and valproate are second-line agents given after the benzodiazepine fails. High-dose repeated IM midazolam at 0.5 mg/kg risks respiratory depression and is not the standard initial protocol.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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