Seizure / Status Epilepticus

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Quick links · seizure types & pathways
Seizure overviewStatus EpilepticusEclampsia (pregnancy)OB EmergenciesAlcohol withdrawalToxic ingestionFebrile seizure (peds)Hypoglycemia
First-line (benzos)

  • Status epilepticus

    IV/IO/IM
    Adult: 4 mg IV q5-10 min
    IV/IO/IM• 2 mg/mL• 0.1 mg/kg

  • Status epilepticus

    IM/IN/Buccal
    Adult: 10 mg IM
    IM/IN/Buccal• 5 mg/mL• 0.2 mg/kg

  • Status epilepticus

    IV
    Adult: 5-10 mg IV
    IV slow push• 5 mg/mL• 0.2 mg/kg

  • Status epilepticus, no IV

    Per
    Per rectum• 5 mg/mL gel• 0.5 mg/kg
Second-line

  • 2nd line status

    IV
    Adult: 60 mg/kg, max 4.5 g
    IV over 15 min• 100 mg/mL• 60 mg/kg

  • 2nd line status

    IV/IM,
    Adult: 20 mg PE/kg
    IV/IM, max rate 150 mg/min• 50 mg PE/mL• 20 mg PE/kg
Status timeline
0-5 min: Stabilize, glucose, IV. 5-20 min: × 2. 20-40 min: Levetiracetam OR Fosphenytoin OR Valproate. >40 min: RSI + continuous infusion (, , ).