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Intravenous diazepam

• Doses : 0,3 mg/kg

. Should be administered slowly over 2-3 min

while closely monitoring respiratory conditions

Fukuyama, concensus statement of FS’1996.



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 continuousinfusion (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 anydecrease in blood pressure.

» Fukuyama, consensus statement of FS,1996.



Table 1 : Emergency department anticonvulsantsguideline CPS’ 2003

LONGER-ACTING ANTICONVULSANTS / ACUTE CESSATION AND PREVENTION

Phenytoin*(IV,IQ)

20 mg/kg1000 mg

(30 mg/kg)1 mg/kg/min

May giveadditional 5mg/kg IV ifunable to

stop seizure

Hypotension,arrtythmia, need to

be on cardiacmonitor

Must be given in nonglucosecontainingsolution

Phenobarbital*(IV,10)

20mg/kg

600 mg(30 mg/kg)

1 mg/kg/min

First choice inneonates

Respiratorydepression,especially ifValium has beenused

Drug and Route Dose Max RisksRate Repeat Comments



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Table 1 : Emergency department anticonvulsantsguideline CPS’ 2003

Drug andRoute

SHORTER TERM / ACUTE CESSATION OF SEIZURE

Dose Max Rate Repeat Risks Comments

Diazepam(PR)

0.5mg/kg

10 mg q5-10 minUse undiluted IVpreparation

Diazepam(IV,IO)

0.3mg/kg

10 mg< 2mg/min

q5min x2-3

Administrator asclose to vein as

possible without

dilution



PENANGANAN KEJANG & KONVULSIF STATUS EPILEPTICUS

(UKK ’2006)

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 60-90min20mg/kg/iv(rate >10min;

Hospital/ED

Lorazepam 0,05-0,1mg/kg/iv

(rate <2mg/min)

0-10min

20-30minICU/ED

ICU Refracter SE



Refractory Status Epilepticus*

Midazolam 0.2 mg/kg IV, follow by 0.02-0.4 mg/kg/hrventilatory 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

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