Status epilepticus (peds) - Revision history

Danbot: Add peer-reviewed reference

2026-03-22T10:16:04Z

Add peer-reviewed reference

← Older revision		Revision as of 10:16, 22 March 2026
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	==Clinical Features==		==Clinical Features==
	*Unresponsive patient with either:		*Unresponsive patient with either:<ref>Glauser T, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults. Epilepsy Curr. 2016;16(1):48-61. PMID 26900382</ref>
	**Seizure >5 min and/or ongoing seizure on presentation		**Seizure >5 min and/or ongoing seizure on presentation
	**2 or more seizures without full recovery of consciousness between seizures		**2 or more seizures without full recovery of consciousness between seizures

Danbot: Add MedicationDose entries (midazolam, dextrose) with SMW annotations

2026-03-20T18:48:51Z

Add MedicationDose entries (midazolam, dextrose) with SMW annotations

← Older revision		Revision as of 18:48, 20 March 2026
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	{{Pediatric anticonvulsants}}		{{Pediatric anticonvulsants}}


			==Medication Dosing==
			{{MedicationDose
			\| drug = Midazolam
			\| dose = 0.2mg/kg IM/intranasal (max 10mg/dose)
			\| route = IM/IN
			\| context = Prehospital first-line for pediatric status epilepticus
			\| indication = Status epilepticus (peds)
			\| population = Pediatric
			}}
			{{MedicationDose
			\| drug = Dextrose
			\| dose = D25W 2mL/kg (max 100mL) or D10W 5mL/kg (max 250mL)
			\| route = IV
			\| context = If blood glucose <60mg/dL
			\| indication = Status epilepticus (peds)
			\| population = Pediatric
			}}

	==Disposition==		==Disposition==

Ostermayer at 20:52, 17 January 2026

2026-01-17T20:52:00Z

← Older revision		Revision as of 20:52, 17 January 2026
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	{{~~Peds top~~}} ~~[[Status epilepticus]].''~~		{{PediatricPage\|Status epilepticus}}
	==Background==		==Background==
	For a child over 1 month of age		For a child over 1 month of age

Cdichang: /* Workup */

2022-12-13T16:14:10Z

Workup

← Older revision		Revision as of 16:14, 13 December 2022
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	*If indicated, consider:		*If indicated, consider:
	**Anticonvulsant drug levels		**Anticonvulsant drug levels
	**~~Electrolyte panel~~, a blood gas, ~~CBC~~, ~~calcium~~ level~~, LFTs~~		**CMP, CBC, blood gas, calcium, magnesium level
	**Blood & urine culture		**Blood & urine culture
	**CT head if concern for blood, infectious process, mass		**CT head if concern for blood, infectious process, mass

Cdichang: /* Workup */

2022-12-13T16:13:28Z

Workup

← Older revision		Revision as of 16:13, 13 December 2022
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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	* Check a blood glucose		*Check a blood glucose
	* ~~Consider an electrolyte~~ panel, a blood gas, CBC, calcium level, LFTs		*If indicated, consider:
	* ~~If appropriate collect anticonvulsant drug levels~~		**Anticonvulsant drug levels
	* ~~Consider blood~~ & urine culture		**Electrolyte panel, a blood gas, CBC, calcium level, LFTs
	* ~~Consider~~ head ~~imaging~~ if concern for blood, infectious process, mass		**Blood & urine culture
	** ~~Consider lumbar~~ puncture if febrile, concerns for meningitis/encephalitis (may be afebrile), or localized/focal neurological findings		**CT head if concern for blood, infectious process, mass
	* ~~Consider toxicology~~ studies		**Lumbar puncture if febrile, concerns for meningitis/encephalitis (may be afebrile), or localized/focal neurological findings
	* ~~Consider~~ EKG to evaluate for arrhythmias, toxins and electrolyte abnormalities		**Toxicology studies
			**EKG to evaluate for arrhythmias, toxins and electrolyte abnormalities

	==Management==		==Management==

Cdichang at 16:11, 13 December 2022

2022-12-13T16:11:41Z

← Older revision		Revision as of 16:11, 13 December 2022
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	* EIIC-TREKK Pediatric Status Epilepticus Algorithm. April 2022 Version: 4.0 Review date: 2024. https://emscimprovement.center/education-and-resources/peak/peak-status-epilepticus/trekk-eiic-pediatric-status-epilepticus-practice-guideline/.		* EIIC-TREKK Pediatric Status Epilepticus Algorithm. April 2022 Version: 4.0 Review date: 2024. https://emscimprovement.center/education-and-resources/peak/peak-status-epilepticus/trekk-eiic-pediatric-status-epilepticus-practice-guideline/.
	* Kristinsson, George. Status Epilepticus. PEM GUIDES. 7th edition. NYU Langone Health; 2020: 551-557.		* Kristinsson, George. Status Epilepticus. PEM GUIDES. 7th edition. NYU Langone Health; 2020: 551-557.
			* Medical Review Committee. Cincinnati Children's Hospital Medical Center. https://mrc.pemcincinnati.com/status-epilepticus/

	[[Category:Pediatrics]]		[[Category:Pediatrics]]

Cdichang: /* Management */

2022-12-13T16:04:42Z

Management

← Older revision		Revision as of 16:04, 13 December 2022
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	==Management==		==Management==
	====Prehospital====		====Prehospital====
	* Give Midazolam 0.2 mg/kg/dose IM/intranasal (MAX 10 mg/dose)		*Give Midazolam 0.2 mg/kg/dose IM/intranasal (MAX 10 mg/dose)
	* Check blood glucose		*Check blood glucose
	** If blood glucose <3.3 mmol/L (<60 mg/dL): Treat with D25W 2 mL/kg/dose IV (MAX 100 mL/dose) OR D10W 5 mL/kg/dose IV (MAX 250 mL/dose).		**If blood glucose <3.3 mmol/L (<60 mg/dL): Treat with D25W 2 mL/kg/dose IV (MAX 100 mL/dose) OR D10W 5 mL/kg/dose IV (MAX 250 mL/dose).
	** If ≥3.3 mmol/L (≥60 mg/dL): Give second dose of Midazolam 0.2 mg/kg/dose IM/intranasal (MAX cumulative dose of 10 mg in prehospital setting; if max dose given, consult Medical Director/Base Hospital for next step).		**If ≥3.3 mmol/L (≥60 mg/dL): Give second dose of Midazolam 0.2 mg/kg/dose IM/intranasal (MAX cumulative dose of 10 mg in prehospital setting; if max dose given, consult Medical Director/Base Hospital for next step).
			*Provide [[O2]] via positive pressure ventilation with BVM/flow inflating bag
			**Likely apneic/hypoventilating/hypercapneic
			**Only apply CPAP or a non-rebreather if patient stops seizing and has adequate chest rise

	====Emergency Department====		====Emergency Department====

Cdichang: /* Management */

2022-12-13T15:32:42Z

Management

← Older revision		Revision as of 15:32, 13 December 2022
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	==Management==		==Management==
	~~{{Initial management of pediatric status epilepticus}}~~

	~~===Phase 1 (5-15 minutes)===~~
	====Prehospital====		====Prehospital====
	* Give Midazolam 0.2 mg/kg/dose IM/intranasal (MAX 10 mg/dose)		* Give Midazolam 0.2 mg/kg/dose IM/intranasal (MAX 10 mg/dose)
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	====Emergency Department====		====Emergency Department====
	* Give a benzodiazepine (if two doses not already given prior to ED arrival). Give a second dose for ongoing seizure after 5 minutes. Do not give more than two doses (apnea risk).
	** With IV/IO access: Lorazepam 0.1 mg/kg/dose IV/IO (MAX 4 mg/dose) OR Midazolam 0.1 mg/kg/dose IV/IO (MAX 10 mg/dose)
	** No IV/IO Access: Midazolam 0.2 mg/kg/dose IM/intranasal (MAX 10 mg/dose)
	* Check blood glucose and respond as above if not already done
	* Give acetaminophen 15 mg/kg/dose (MAX 650 mg) if febrile

	~~===Phase 2 (15-50 minutes)===~~		{{Initial management of pediatric status epilepticus}}
	* Give Levetiracetam, Phenytoin/Fosphenytoin or Valproic acid (equally efficacious for status epilepticus)
	** Levetiracetam is preferred given quick administration, favorable side effect profile, and less drug interactions
	* If still seizing 5 minutes following medication infusion, choose another second-line agent to give and contact a referral site
	** Do not combine Phenytoin and Fosphenytoin

	~~===Phase 3 (50 minutes onwards)===~~
	* Prepare for airway support given apnea risk
	* Consider third-line options; continuous IV infusion of Midazolam, Pentobarbital, Propofol OR Ketamine
	* Discuss further management with Pediatric Referral Site

	{{Pediatric anticonvulsants}}		{{Pediatric anticonvulsants}}

Cdichang: /* Differential Diagnosis */

2022-11-21T18:35:57Z

Differential Diagnosis

← Older revision		Revision as of 18:35, 21 November 2022
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	* Genetic condition		* Genetic condition

	Consider other [[Pediatric seizure ~~DDX~~]]		Consider other causes of [[Pediatric seizure]]

	==Evaluation==		==Evaluation==

Cdichang: /* Differential Diagnosis */

2022-11-21T18:34:23Z

Differential Diagnosis

← Older revision		Revision as of 18:34, 21 November 2022
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	* Genetic condition		* Genetic condition

	{{Pediatric seizure DDX}}		Consider other [[Pediatric seizure DDX]]

	==Evaluation==		==Evaluation==