A 4-year-old child presents with a generalized tonic-clonic seizure that has lasted 8 minutes despite lying the child in a safe position and ensuring airway patency. Intravenous access has been established. What is the first-line drug and correct dose for this child?

• A IV diazepam 0.3 mg/kg
• B IV phenytoin 20 mg/kg
• C IV lorazepam 0.1 mg/kg ✓
• D IV midazolam 0.3 mg/kg

Explanation

This child is in convulsive status epilepticus as the seizure exceeds 5 minutes. IV lorazepam 0.1 mg/kg is the first-line benzodiazepine per protocol. Diazepam is an alternative but lorazepam is preferred due to longer duration of action. Phenytoin is a second-line agent used if benzodiazepines fail. Buccal or intranasal midazolam is used when IV access is unavailable.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.