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Medications

Acute 
The majority of respondents from the Divisions of Child Neurology, Emergency Medicine, and Hospital Medicine recommend prescribing ANY benzodiazepine for abortive therapy. However, a consensus, as defined by 75% of respondents, for a particular agent was not reached.

Recommended doses for medications:

ED/UCC/INPATIENT

  • Lorazepam- 0.1mg/kg (max of 4mg) IV every 5 minutes x3 doses OR

  • Midazolam- 0.2mg/kg (max 10mg) Intranasal until IV line is established 

Outpatient meds for seizure recurrence
Consensus from the Divisions of Child Neurology, Emergency Medicine, and Hospital Medicine was NOT reached regarding prescription of a benzodiazepine at the time of discharge for community use as abortive therapy for potential recurrence of a prolonged complex febrile seizure. Therefore, we do not recommend prescribing a benzodiazepine for all patients at discharge. However, this could be considered based on individual or parent factors, and provider comfort.

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.