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Underdosing Initial Benzodiazepines for Seizures? | Status Epilepticus | #CODEBLUEDEBRIEF


 


 

Acutely terminating seizures often puts us in a dilemma; too little and underdose, or too much and toxicities. Working along this spectrum requires a general understanding of the guidelines recommendations. It'll also be good for you to understand benzodiazepine pharmacokinetics. Let's review initial benzodiazepine dosing in the treatment of status epilepticus (SE)!


Welcome to PHARMWYZE! Clinical pharmacotherapy content made for learners of all medicine backgrounds. Thanks for joining me on the Code Blue Debrief YouTube & Podcast series. The focus will be evidence-based medicine and pharmacotherapy topics for emergency medicine and critical care learners. I've shifted content development into longer formats and would love to hear your input!


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References

Lee, S. Diagnosis and Treatment of Status Epilepticus. J Epilepsy Res. 2020 Dec 31;10(2):45-54.

Kapur et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019 Nov 28;381(22):2103-2113.

Kohl et al. Status epilepticus and benzodiazepine treatment: Use, underdosing and outcome - insights from a retrospective, multicentre registry. Seizure. 2023 Apr;107:114-120. doi: 10.1016/j.seizure.2023.03.020.

Silbergleit et al. RAMPART (Rapid Anticonvulsant Medication Prior to Arrival Trial): a double-blind randomized clinical trial of the efficacy of intramuscular midazolam versus intravenous lorazepam in the prehospital treatment of status epilepticus by paramedics. Epilepsia . 2011 Oct;52 Suppl 8(Suppl 8):45-7.

Sathe et al. Underdosing of Benzodiazepines in Patients With Status Epilepticus Enrolled in Established Status Epilepticus Treatment Trial. Acad Emerg Med . 2019 Aug;26(8):940-943. Glauser et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016 Jan-Feb; 16(1): 48–61.

Leppik IE et al. Double-blind study of lorazepam and diazepam in status epilepticus. JAMA 1983;249:1452–1454.

Alldredge BK et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 2001;345:631–637.

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