A 4-year-old child presents with a generalized tonic-clonic seizure lasting 8 minutes. Intravenous access is not yet established. What is the most appropriate immediate treatment?
- A Intravenous phenytoin 20 mg/kg
- B Rectal diazepam 0.5 mg/kg ✓
- C Intramuscular phenobarbitone 20 mg/kg
- D Oxygen via face mask and wait for IV access
Correct answer: B. Rectal diazepam 0.5 mg/kg
Explanation
Rectal diazepam (0.5 mg/kg) is the recommended first-line treatment for acute prolonged seizures when IV access is not available, as it is rapidly absorbed and acts quickly. Intravenous lorazepam or diazepam is preferred if access is available. Phenytoin is a second-line agent. Phenobarbitone is also second-line. Simply waiting without anticonvulsant therapy is inappropriate for a seizure lasting over 5 minutes.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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