Pediatric Convulsive Status Epilepticus
Seizure ≥5 minutes or 2+ seizures without recovery
All Pathways
PediatricsEmergency
Pediatric Status Epilepticus (AES 2016)
Pediatric Status Epilepticus (AES 2016): Pediatric Convulsive Status Epilepticus → Stabilization (0-5 min) → First-Line: Benzodiazepine (5-10 min) → Sei...
Pathway Overview
10 steps
Algorithm Steps
10 total
01Start 02Action Stabilization (0-5 min)
Initial stabilization measures
- Time the seizure
- ABCs: Position, suction, O2, monitor
- Establish IV access (if possible)
- Check glucose - treat if hypoglycemic
- Place in recovery position if no IV yet
03Action First-Line: Benzodiazepine (5-10 min)
Give benzodiazepine immediately
- WITH IV ACCESS:
- • Lorazepam 0.1 mg/kg IV (max 4 mg) - PREFERRED
- • OR Diazepam 0.15-0.2 mg/kg IV (max 10 mg)
- WITHOUT IV ACCESS:
- • Midazolam 0.2 mg/kg IM (max 10 mg) - PREFERRED
- • OR Diazepam 0.3-0.5 mg/kg PR (max 20 mg)
- • OR Midazolam 0.2 mg/kg intranasal
04Decision Seizure Stopped?
Reassess after 5 minutes
05Outcome Seizure Controlled
Post-ictal care and monitoring
- Monitor for recurrence
- Complete workup: Labs, glucose, electrolytes
- Consider LP if infection suspected
- Obtain EEG when stable
- Start maintenance AED as appropriate
- Admit for observation
06Action Second Benzodiazepine Dose (10-15 min)
Repeat benzodiazepine if seizure continues
- Repeat same dose of first-line benzodiazepine
- • Lorazepam 0.1 mg/kg IV (max 4 mg)
- • OR Midazolam 0.2 mg/kg IM if no IV
- Establish IV/IO access if not already done
07Decision Seizure Stopped?
Reassess after second benzodiazepine
- Path rejoins step 05Shared downstream outcome
08Action Second-Line AED (15-30 min)
Add antiepileptic drug for benzodiazepine-refractory SE
- Choose ONE:
- • Fosphenytoin 20 mg PE/kg IV (max 1500 mg PE)
- - Infuse at 3 mg PE/kg/min (max 150 mg PE/min)
- • OR Levetiracetam 40-60 mg/kg IV (max 4500 mg)
- - Infuse over 15 minutes
- • OR Valproate 40 mg/kg IV (max 3000 mg)
- - Avoid if metabolic disease, hepatic failure
09Decision Seizure Stopped?
Reassess after second-line AED
- Path rejoins step 05Shared downstream outcome
10Warning Refractory Status Epilepticus (>30 min)
ICU-level care required
- Prepare for intubation and continuous infusion
- Continuous EEG monitoring if available
- Options (consult neurology):
- • Midazolam infusion: 0.2 mg/kg bolus, then 0.1-0.4 mg/kg/hr
- • Pentobarbital: 5-15 mg/kg bolus, then 0.5-5 mg/kg/hr
- • Propofol (>3 yrs): 1-2 mg/kg bolus, then 1-5 mg/kg/hr
- • Ketamine: 1-2 mg/kg bolus, then 1-5 mg/kg/hr
- Titrate to burst-suppression on EEG
Guideline Source
AES Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus 2016
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address neonatal seizures (different management)
- Specific doses for refractory SE may vary by institution
- EEG monitoring ideal but not always available emergently
Applicable Regions
USEU
Version 1Next review: 2027-01-11
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the Pediatric Status Epilepticus (AES 2016)?
The Pediatric Status Epilepticus (AES 2016) is a emergency clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on AES Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus 2016.
What guideline is the Pediatric Status Epilepticus (AES 2016) based on?
This algorithm is based on AES Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus 2016 (DOI: 10.5698/1535-7597-16.1.48).
What are the limitations of the Pediatric Status Epilepticus (AES 2016)?
Known limitations include: Does not address neonatal seizures (different management); Specific doses for refractory SE may vary by institution; EEG monitoring ideal but not always available emergently. Individual patient factors may require deviation from these recommendations.
Get AI-Powered Analysis Alongside This Algorithm
In AttendMe.ai, the Pediatric Status Epilepticus (AES 2016) appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.
Try AttendMe Free