A 7-year-old child with known seizure disorder is brought in with a generalized tonic-clonic seizure lasting 12 minutes. IV access is established. The first dose of lorazepam 0.1 mg/kg is given but the seizure continues. What is the next step in management per current status epilepticus protocols?
- A Repeat lorazepam 0.1 mg/kg IV
- B Administer phenobarbitone 20 mg/kg IV
- C Administer levetiracetam 60 mg/kg IV infusion ✓
- D Proceed to rapid sequence intubation immediately
Correct answer: C. Administer levetiracetam 60 mg/kg IV infusion
Explanation
After failure of one dose of a benzodiazepine (first-line), current evidence-based pediatric status epilepticus protocols recommend a second-line antiepileptic: levetiracetam 60 mg/kg IV, valproate 40 mg/kg IV, or phenytoin/fosphenytoin 20 mg/kg. Levetiracetam has become preferred in many centers due to its safety profile and ease of administration. A second benzodiazepine dose may be given if IV access was not available for the first dose, but repeating lorazepam is not the standard next step after IV lorazepam failure.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.