How to manage convulsions in a 5 kg boy?

From the Guidelines

To manage convulsions in a 5 kg boy, first ensure airway, breathing, and circulation are maintained while positioning the child on his side to prevent aspiration, then administer lorazepam 0.1 mg/kg (0.5 mg) i.v. as the initial treatment, which can be repeated after at least 1 minute if seizures persist, as recommended by the most recent guidelines 1. When managing convulsions in this patient, it is crucial to follow a step-wise approach.

• Ensure airway protection and provide high-flow oxygen, as well as check the blood glucose level to rule out hypoglycemia as a cause of seizures.
• If IV access is available, lorazepam 0.1 mg/kg (0.5 mg) i.v. is the preferred initial treatment, which can be repeated after at least 1 minute if seizures persist, according to the guidelines 1.
• If seizures continue beyond 5 minutes, a second dose of benzodiazepine can be administered.
• For seizures lasting more than 15-20 minutes, second-line therapy with levetiracetam 40 mg/kg i.v. bolus or phenobarbital 10-20 mg/kg i.v. can be considered, as suggested by recent management guidelines 1.
• Continuous monitoring of vital signs, oxygen saturation, and blood glucose levels is essential, with supplemental oxygen and dextrose administration as needed. The choice of medication and the approach to management are guided by the need to rapidly control seizures while minimizing the risk of adverse effects, as emphasized in recent studies 1.

From the Research

Management of Convulsions in a 5 kg Boy

To manage convulsions in a 5 kg boy, the following options can be considered:

• Intramuscular (IM) administration of antiepileptic drugs (AEDs) such as midazolam (MDZ) or diazepam (DZP) 2
• Rectal administration of DZP, which has been shown to be effective in reducing seizure frequency in children 2
• Intravenous (IV) administration of lorazepam (LOR), which is recommended as the first-line treatment for status epilepticus 3, 4, 5, 6

Treatment Options

The following treatment options can be considered:

• Midazolam (MDZ) autoinjector delivering IM drug, which has been shown to be effective in treating status epilepticus 2
• Diazepam (DZP) administered rectally, which has been shown to be effective in reducing seizure frequency in children 2
• Lorazepam (LOR) administered IV, which is recommended as the first-line treatment for status epilepticus 3, 4, 5, 6
• Levetiracetam (LEV) administered IV, which has been shown to be effective in treating status epilepticus and may be preferred in patients with respiratory compromise and hypotension 4

Dosage and Administration

The dosage and administration of the treatment options should be considered:

• Midazolam (MDZ) autoinjector delivering IM drug: the dosage is not specified in the provided evidence
• Diazepam (DZP) administered rectally: the dosage ranged from 0.2 to 0.5 mg/kg in a study 2
• Lorazepam (LOR) administered IV: the recommended dose is 0.1 mg/kg/dose, up to a maximum of 4 mg 5
• Levetiracetam (LEV) administered IV: the dosage is 20 mg/kg IV over 15 min in a study 4