Adult Generalized Convulsive Status Epilepticus Guidelines
Access and control airway, vital signs, pulse-oximetry & oxygen (100% NRB)
Perform blood & fingerstick glucose, serum electrolytes, Ca, Mg, drug level
Administer thaimine (100mg) then glucose (50ml of 50% dextrose)
Pregnancy   Toxicologic Seizures
Women in 2nd half of 2nd trimester, If drug of toxin-induced seizures are possible, one should consider these causes of seizures which may require additional therapeutic modalities:
3rd trimester or 1 week post-partum carbon monoxide                        hyperbaic therapy
administer 4 grams magnesium sulfate cocaine                    high doses of benzodiazepines
followed by 2 g/hr and consult OB/GYN cyanide                                    cyanide antidote kit
cyclic antidepressants              bicarbonate therapy
isoniazid                                    pyridoxine therapy
lithium                           hydration and hemodialysis
organophosphates                  atropine and 2-PAM
theophylline                       charcoal hemoperfusion
Start anticonvulsant therapy
1. Lorazepam 0.1mg/kg (maximum rate of 2mg/min)
(1:1 dilution in D5W or NS)
If no response after 5 minutes, repeat X 2 doses
If seizures continue:
2. Fosphenytoin 20mg/kg PE IV loading dose (rate not to exceed 150mg/min PE)
(dilute in D5W or NS to provide 1.5-25mg PE/ml)
If no response after 30 minutes, repeat fosphenytoin 5-10mg/kg PE IV
If seizures continue:
Patient requires intubation Patient requires intubation Special Circumstances
    (ex. non ICU patients, DNI)
Midazolam 0.2mg/kg bolus, followed by 0.75-10mcg/kg/min Phenobarbital* 10-20mg/kg IV (rate not to exceed 100mg/min or 60mg/min IV push)  
OR (dilute in 100-150ml of D5W or NS) Valproic acid* 15-20mg/kg IV to be infused not greater than 3mg/kg/min
Propofol 1-2mg/kg IV, followed by 2-10mg/kg/hr IV (dilute in D5W or NS to a maximum concentration of 4mg/ml)
Pentobarbital 10-15mg/kg IV over 1 hour, followed by 0.5-1mg/kg/hr
EEG Monitoring Recommended
* Check antileptic drug serum concentration 1-2 hours post loading dose.  Once seizures are controlled, start maintenance therapy.  Closely monitor blood pressure, respiratory rate, and cardiac rhythm
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