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Treatment of convulsive status epilepticus in adults

Note that all infusion rates should be adjusted to individual patients; maximum doses listed are not always required.

ABG: arterial blood gas; CBC: complete blood count; IV: intravenous; LFTs: liver function tests; PE: phenytoin equivalent. * There is no definite maximum dose of lorazepam; clinicians should be guided by the clinical effect (including on blood pressure) and seizure control. Δ Cardiac monitoring required. Phenytoin or fosphenytoin may be ineffective for toxin-induced seizures and may intensify seizures caused by cocaine and other local anesthetics. ◊ Begin continuous infusion of one of the three drugs below. Selection of an agent depends upon the need for rapid seizure control, the patient's respiratory and hemodynamic status, and medical comorbidities. Most neurologists start with midazolam or propofol. Clinicians should generally use medications they and the care team are familiar with, in order to avoid unintended complications of therapy. § May substitute valproic acid, lacosamide, or levetiracetam if allergic to phenytoin or phenobarbital, or if they cause other serious side effects.

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