A 3-year-old child is brought with fever, altered consciousness, and generalized tonic-clonic seizures lasting 35 minutes. IV lorazepam 0.1 mg/kg was given twice without effect. Which is the next most appropriate drug?
- A IV phenobarbitone 20 mg/kg
- B IV phenytoin/fosphenytoin 20 mg/kg PE ✓
- C IV levetiracetam 40–60 mg/kg
- D Rectal diazepam 0.5 mg/kg
Correct answer: B. IV phenytoin/fosphenytoin 20 mg/kg PE
Explanation
After failure of two doses of benzodiazepine (established status epilepticus), the next step per pediatric PALS/IAP guidelines is IV phenytoin 20 mg/kg (or fosphenytoin 20 mg/kg PE) infused over 20 minutes. Levetiracetam is an acceptable alternative where phenytoin is unavailable but phenytoin/fosphenytoin remains the standard second-line agent. Phenobarbitone (option A) is the third-line agent. Rectal diazepam is appropriate for pre-hospital first-aid, not for refractory in-hospital status.
Reference: Ghai Essential Pediatrics, 10th ed.
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