MedBalans

Status Epilepticus

Adults · emergency only · brief protocol

Algorithm

  1. Time the seizure; protect airway; recovery position if vomiting; O₂; check glucose.
  2. IV access; benzodiazepine first-line as soon as IV/IM/buccal available (do not wait for labs).
  3. If seizures continue: second-line antiseizure medication (levetiracetam / valproate / fosphenytoin per local protocol).
  4. Refractory: anesthetic agent + ICU / EEG; treat cause (infection, metabolic, structural).
  5. Imaging and LP when indicated after stabilization.

Red flags

  • • Hypoglycemia / hypoxia
  • • Refractory seizures >30–60 min
  • • Pregnancy — eclampsia pathway

Medications by step

1st line

  • Lorazepam IV or midazolam IM/buccal/intranasal · IV / IM / buccal

    Lorazepam ~4 mg IV (adult); midazolam per local adult dose

2nd line

  • Levetiracetam or valproate or (fos)phenytoin · IV

    Per local status protocol (e.g. LEV 40–60 mg/kg IV, max per protocol)

References

  • • AES / AAN status epilepticus guidance (principles) (2016)

Updated: July 2026