From the Guidelines
For a 9-year-old female weighing 30kg with focal seizures who is already on Keppra 250mg, I recommend administering Ativan (lorazepam) at a dose of 0.05 mg/kg IV, which would be 1.5 mg total, as per the guidelines outlined in 1. This dose is based on the management guidelines for pediatric patients, which suggest an initial dose of 0.05 mg/kg (maximum 1 mg) intravenous (i.v.) lorazepam to control electrographical seizures. The medication should be administered slowly over 2-5 minutes to minimize respiratory depression. If IV access is unavailable, the same dose can be given intramuscularly or rectally, though absorption may be slower. Monitor vital signs, especially respiratory rate and oxygen saturation, during and after administration. Ativan works by enhancing the inhibitory effects of GABA in the brain, which helps terminate seizure activity. Be prepared for potential side effects including sedation, respiratory depression, and hypotension. Some key points to consider in the management of this patient include:
- Assessing circulation, airway, and breathing (CAB) and providing airway protection interventions, as well as administering high-flow O2 and checking blood glucose level, as outlined in 1 and 1.
- Considering a transfer to the pediatric intensive-care unit (PICU) if seizures persist, as suggested in 1 and 1.
- Potential adjustment of the current Keppra dose, as 250mg may be lower than typically used for a child of this weight, and considering additional medications such as phenobarbital if seizures persist, as outlined in 1 and 1. It is essential to consult with a pediatric neurologist for ongoing management to ensure the best possible outcome for the patient.
From the Research
Dosing of Ativan (Lorazepam) for a 9-Year-Old Female Patient
- The patient is already on 250mg Keppra (levetiracetam) and presents with focal seizures.
- To determine the appropriate dose of Ativan (lorazepam), we need to consider the patient's weight and age.
- According to the provided studies, there is no direct information on the dosing of Ativan (lorazepam) for a 9-year-old female patient weighing 30kg.
- However, study 2 mentions that lorazepam was administered in two doses to a patient with status epilepticus, but the dose is not specified.
- Study 3 discusses the use of intravenous levetiracetam in children with acute seizures, but does not provide information on lorazepam dosing.
- Study 4 mentions the administration of lorazepam to a 9-month-old girl, but the dose is not relevant to a 9-year-old patient.
- Study 5 compares levetiracetam with fosphenytoin as a second-line treatment after diazepam for status epilepticus, but does not provide information on lorazepam dosing for a 9-year-old patient.
Considerations for Dosing
- The patient's weight is 30kg, and the age is 9 years.
- The typical dose of lorazepam for seizures in children is not specified in the provided studies.
- It is essential to consult a pediatric neurology or emergency medicine reference to determine the appropriate dose of lorazepam for this patient.
- The dose of lorazepam may vary depending on the severity of the seizures, the patient's medical history, and other factors.
- Studies 4, 2, 5, 3 do not provide sufficient information to determine the appropriate dose of lorazepam for this patient.