Intravenous diazepam

Doses : 0,3 mg/kg

. Should be administered slowly over 2-3 min
while closely monitoring respiratory conditions

Fukuyama, concensus statement of FS1996.
Protocol Diazepam infusion
for refractory status epilepticus
Diazepam 50 mg is diluted in a solution of 250
ml 0,9% NaCl or D5W and run as a continuous
infusion (2 mg/kg/h)

Medical college of Virginia status epilepticus in children
Continuous Midazolam Infusion
Pediatric Studies
Initial bolus : 150 200 ug /kg IV
Drip rate : 1 10 ug/kg/min
(2-5 typical)
Phenobarbital : 20 mg/kg IV over 10-20 min
AOCCN, CEBU 2007
3
Intravenous Phenytoin
Doses : 15-20 mg/kg

Should be given slowly by intravenous drip infusion over
20 min while monitoring closely for arrhythmia or any
decrease in blood pressure.

Fukuyama, consensus statement of FS,1996.
5
Table 1 : Emergency department anticonvulsants
guideline CPS 2003
LONGER-ACTING ANTICONVULSANTS / ACUTE CESSATION AND PREVENTION
Phenytoin*
(IV,IQ)
20 mg/kg
1000 mg
(30 mg/kg)
1 mg/kg/min
May give
additional 5
mg/kg IV if
unable to
stop seizure
Hypotension,
arrtythmia, need to
be on cardiac
monitor
Must be given in non
glucosecontaining
solution
Phenobarbital*
(IV,10)
20
mg/kg
600 mg
(30 mg/kg)
1 mg/kg/
min
First choice in
neonates
Respiratory
depression,
especially if
Valium has been
used
Drug and Route Dose Max Risks Rate Repeat Comments
6
Table 1 : Emergency department anticonvulsants
guideline CPS2003
Drug and
Route
SHORTER TERM / ACUTE CESSATION OF SEIZURE
Dose Max Rate Repeat Risks Comments
Diazepam
(PR)
0.5
mg/kg
10 mg q5-10 min

Use undiluted IV
preparation
Diazepam
(IV,IO)
0.3
mg/kg
10 mg
< 2
mg/min
q5min x
2-3
Administrator as
close to vein as
possible without
dilution
7
Protokol Pengunaan Midazolam pada
Refrakter SE
Rawat di ICU, intubasi dan berikan ventilasi
Midazolam bolus 0.2 mg/kg (perlahan), kemudian
drip 0,02-0,4 mg/kg/hr
Rumatan fenitoin dan fenobarbital tetap diberikan
Dosis midazolam diturunkan bila terdapat gangguan
kardiovaskuler.
Infus di tapering bila 12 jam tidak terlihat kejang.

PENANGANAN KEJANG & KONVULSIF STATUS EPILEPTICUS
(UKK2006)
Diazepam 5-10mg rektal
( max 2x , jarak 5 menit)

Prehospital
Airway
Breathing
Circulation
Diazepam 0,25-0,5mg/kg/iv
(rate 2mg/min, max dose 10mg)
Midazolam 0,2mg/kg/iv/im
atau
atau
10-20min
Phenytoin
20mg/kg/iv
(>20min /50ml NS)

Phenobarbital

60-90min
20mg/kg/iv(rate >10min;
Hospital/ED
Lorazepam 0,05-0,1mg/kg/iv
(rate <2mg/min)
0-10min
20-30min ICU/ED
ICU Refracter SE
Refractory Status Epilepticus*
Midazolam 0.2 mg/kg IV, follow by 0.02-0.4 mg/kg/hr
ventilatory support

*Best managed in the pediatric intensive care unit
Midazolam IM
Diazepam IV 20 mg sama efektifnya dengan
midazolam 15 mg IM
Pasien dengan status epileptikus: Kejang berhenti
setelah 2-3 menit

Wasterlain, CG. Status epilepticus, 2006
Thiele, EA. Treatment of pediatric neurology, 2005
Freedman, SB. Clin Pediatric Emergency Medicine, 2003