A 5-year-old child (18 kg) presents in status epilepticus. After two doses of lorazepam have failed, which drug should be administered next as per current PALS guidelines, and what is its dose?

• A Phenytoin 20 mg/kg IV
• B Fosphenytoin 20 mg PE/kg IV ✓
• C Levetiracetam 60 mg/kg IV
• D Valproate 40 mg/kg IV

Explanation

After failure of two benzodiazepine doses (established status epilepticus), fosphenytoin 20 mg phenytoin equivalents (PE)/kg IV is the preferred second-line agent per PALS 2020 guidelines because it can be administered more rapidly than phenytoin and causes less tissue injury if extravasated. Levetiracetam 60 mg/kg is also an acceptable alternative. Phenytoin itself is avoided due to propylene glycol toxicity and slow infusion requirements.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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