A 40-year-old woman is brought with continuous generalized tonic-clonic convulsions for 12 minutes. Intravenous access is secured. Which drug should be administered first?

• A Intravenous phenytoin loading dose
• B Intravenous valproate infusion
• C Oral midazolam
• D Intravenous lorazepam ✓

Explanation

Benzodiazepines are the established first-line therapy for ongoing status epilepticus because they terminate seizures within minutes by enhancing GABA-A mediated chloride conductance. Lorazepam has a long duration of action within the brain compared with diazepam, whose rapid redistribution allows seizure recurrence. Phenytoin and valproate are second-line maintenance agents given after the benzodiazepine, since their onset is too slow to abort the acute event.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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