Some items to note ...
- common management errors include medication under dosing and excessive intervals between medications
- give 2 - 3 doses of benzos (ativan or valium) before considering second line AEDs
- after appropriate dose of benzo and second line AED (phosphenytoin or phenobarbital, if neonate) have been given, the selection of tertiary treatment options for status are more variable. Consult neurology and begin aggressive search for underlying etiology ie electrolyte derangements, hypoglycemia, infectious diseases, trauma and toxins.
- phenobarbital is second line AED of choice for neonates based primarily on its long history of use rather than any particular study
- advantages of phosphenytoin over phenytoin include: lower risk of cardiac dysfunction, lower rates of phlebitis and less severe tissue necrosis if the medication extravasates
- phenobarbital is very sedating; if used consider very close airway monitoring or prophylactic intubation.
- most common etiology of pediatric status is febrile seizure. Exclude CNS infection. Consider empiric treatment with antibiotics and acyclovir until CSF evaluated.
Goldstein, J. MD. "Status Epilepticus in the Pediatric Emergency Department." Clinical Pediatric Emergency Medicine. 2008. v 9: 96-100.
