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Refractory Status Epilepticus — RACP Paediatrics MCQ

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HardNeurology & DevelopmentRefractory Status EpilepticusRACP Paediatrics

A 6-year-old with known epilepsy is brought to the ED in status epilepticus. Buccal midazolam and IV midazolam have failed to terminate the seizure after 20 minutes. What is the next-line anti-seizure medication?

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Correct answer: E — IV phenytoin (or IV levetiracetam)

Status epilepticus protocol after failed benzodiazepines (first and second doses): second-line agents include IV phenytoin (20 mg/kg), IV levetiracetam (40-60 mg/kg), or IV sodium valproate (40 mg/kg). If seizures continue despite second-line agents (refractory status), RSI with thiopentone or midazolam infusion is required.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Status Epilepticus