A 5-month-old infant has had continuous generalized convulsions for 50 minutes despite adequate doses of IV lorazepam twice, IV phenytoin, and midazolam infusion. No metabolic abnormality is found on initial screening. Which drug should be administered next?

• A Pyridoxine 100 mg intravenously ✓
• B Levetiracetam 60 mg/kg intravenously
• C Oral carbamazepine via nasogastric tube
• D Intravenous magnesium sulfate 50 mg/kg

Explanation

Pyridoxine-dependent epilepsy classically presents in infancy as refractory seizures unresponsive to standard anticonvulsants, and guidelines recommend a trial of IV pyridoxine 100 mg in any infant with status epilepticus resistant to benzodiazepines and phenytoin. Response is often dramatic within minutes. Levetiracetam is a reasonable later second-line agent but misses a specifically treatable cause in this age group. Carbamazepine is not given acutely, and magnesium treats hypomagnesemic seizures, which were excluded by screening.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.