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עברית
Apr 29, 2024
Contributor: Aaron Lessen MD
Educational Pearls:
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Lorazepam (Ativan) is dosed at 0.1 mg/kg up to a maximum of 4 mg in status epilepticus
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Some ED protocols only give 2 mg initially
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The maximum recommended dose of levetiracetam (Keppra) is 60 mg/kg or 4.5 g
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In one retrospective study, only 50% of patients received the correct dose of lorazepam
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For levetiracetam, it was only 35% of patients
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Underdosing leads to complications
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Higher rates of intubations
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More likely to progress to refractory status epilepticus
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References
1. Cetnarowski A, Cunningham B, Mullen C, Fowler M. Evaluation of intravenous lorazepam dosing strategies and the incidence of refractory status epilepticus. Epilepsy Res. 2023;190(November 2022):107067. doi:10.1016/j.eplepsyres.2022.107067
2. Sathe AG, Tillman H, Coles LD, et al. Underdosing of Benzodiazepines in Patients With Status Epilepticus Enrolled in Established Status Epilepticus Treatment Trial. Acad Emerg Med. 2019;26(8):940-943. doi:10.1111/acem.13811
Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit
