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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
You are seeing a 4 year old in status epilepticus. The patient is not on anti-epileptics at home. The patient has received benzodiazepines x 3 and fosphenytoin 20 mg/kg. Glucose and electrolytes are normal. The patient is afebrile.
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August 26, 2018 at 12:22 am
Per Uptodate, typical doses are 20-30 mg/kg. However, a recent American Epilepsy Society evidence-based guideline endorses a dose of 60 mg/kg x 1 (max 4.5gm). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749120/pdf/i1535-7511-16-1-48.pdf Second-line options per this guideline are dosed at 20-40-60, ie fosphenytoin 20 mg/kg (max 1.5gm), valproate 40 mg/kg (max 3gm), or levetiracetam 60 mg/kg (max 4.5gm)