An 11-month-old boy has convulsive status epilepticus persisting despite adequate doses of lorazepam, fosphenytoin, and levetiracetam, with continuous EEG confirmation. Structural and metabolic screening including electrolytes and glucose is unremarkable. Which additional agent should be specifically considered at this age?

• A Pyridoxine 100 mg intravenously ✓
• B Magnesium sulfate 50 mg/kg intravenously
• C Thiamine 100 mg intravenously
• D Naloxone 0.1 mg/kg intravenously

Explanation

Pyridoxine-dependent epilepsy presents as refractory seizures in infants under about 18 months, often as status epilepticus resistant to conventional anticonvulsants, and responds dramatically to parenteral pyridoxine. A therapeutic trial is standard in early-infancy refractory status epilepticus. Magnesium addresses hypomagnesemic seizures, thiamine targets infantile beriberi, and naloxone reverses opioid toxicity; none fits an otherwise unexplained refractory presentation at this age.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.