Status epilepticus
Paediatric emergency management · Neurology · Emergency
Convulsion ≥5 min or recurrent seizures without recovery. Secure airway, give oxygen, check glucose and temperature, obtain access.
First-line benzodiazepine (may repeat once after 5–10 min)
Lorazepam IV0.1 mg/kg IV (max 4 mg)Maximum 4 mg
Midazolam (buccal/IM/IN) – no IV access0.3 mg/kg buccal (max 10 mg)Maximum 10 mg
Second-line (if seizing after two benzodiazepine doses)
- Levetiracetam 40–60 mg/kg IV, or phenytoin/fosphenytoin 20 mg/kg IV, or sodium valproate 20–40 mg/kg IV.
- Correct hypoglycaemia (2–5 mL/kg 10% glucose), electrolytes; treat fever/infection.
Refractory
- Rapid-sequence intubation and infusion (midazolam / thiopentone / propofol) with continuous EEG.
- Seek and treat the cause – imaging, toxidromes, metabolic and CNS infection.
Common questions
What is the first step in status epilepticus?
Convulsion ≥5 min or recurrent seizures without recovery. Secure airway, give oxygen, check glucose and temperature, obtain access.
What drug doses are used in status epilepticus?
Lorazepam IV: 0.1 mg/kg IV (max 4 mg). Midazolam (buccal/IM/IN) – no IV access: 0.3 mg/kg buccal (max 10 mg).
About this page
Compiled from standard paediatric references. Verify against a current formulary and your local protocol.
Spotted something wrong? Report an error on this page — corrections from clinicians are welcome and are reviewed before any change is published.
Last reviewed 2026-08-12.