TEAM Case: Ped Status Epilepticus - Dr. Magill

​Define status epilepticus:

• >5 min seizure- impending status epilepticus
• >30 min- established SE
• >60 min- refractory SE

Consider etiologies:

• Trauma/bleed
• AVM Malformation
• Febrile seizures
• Infection
• Tumor
• Subtherapeutic meds
• Lowered threshold with infection
• Stroke
• Cardiac/arrhythmia
• Hypertensive Crisis
• Pyridoxine deficiency/INH overdose
• NMDA receptor Ab
• FIRES

Remember ABCs and supportive care in addition to treating seizures

Learn dosing for hypoglycemic seizure with dextrose

• Rule of 50's

Learn dosing for hyponatremia seizure with 3% NaCl 

Medications
First line:

• Midazolam 0.15 mg/kg IV, 0.3 mg/kg buccal
• Lorazepam 0.05-0.1 mg/kg IV, max 4 mg/dose rpt x 1
• Diazepam 0.05-0.3 mg/kg IV, 0.5 mg/kg PR, max 5 mg

Second line:

• Fospheny load 15-20 mg/kg IV
• Levetiracetam load 15-20 mg/kg IV
• Valproate load 20-40 mg/kg IV

Refractory/Third line:

• Phenobarb load 20 mg/kg IV, 1 mg/kg/min
  
• Pentobarb 5 mg/kg load
  
• Propofol 2.5-3.5 mg/kg IV, rate 0.1-0.3 mg/kg/min
  
• Ketamine 0.5-2 mg/kg IV, rate 5-20 mcg/kg/min
  
• Pyridoxine 70 mg/kg max 5g, repeat as needed

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