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Bagan Kejang

This document provides guidelines for treating status epilepticus in both pre-hospital and hospital settings. It recommends intravenous diazepam or midazolam as initial treatments, followed by phenytoin, phenobarbital, or lorazepam. For refractory status epilepticus that continues after initial treatment, it suggests administering midazolam by intravenous infusion at a dose of 0.2 mg/kg initially followed by 0.02-0.4 mg/kg/hr along with ventilatory support in an intensive care unit setting. The document also notes that intravenous diazepam is as effective as intramuscular midazolam for stopping seizures within 2-3 minutes in patients experiencing

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279 views

Bagan Kejang

This document provides guidelines for treating status epilepticus in both pre-hospital and hospital settings. It recommends intravenous diazepam or midazolam as initial treatments, followed by phenytoin, phenobarbital, or lorazepam. For refractory status epilepticus that continues after initial treatment, it suggests administering midazolam by intravenous infusion at a dose of 0.2 mg/kg initially followed by 0.02-0.4 mg/kg/hr along with ventilatory support in an intensive care unit setting. The document also notes that intravenous diazepam is as effective as intramuscular midazolam for stopping seizures within 2-3 minutes in patients experiencing

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Nie' MK
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Intravenous diazepam

Doses : 0,3 mg/kg


. Should be administered slowly over 2-3 min
while closely monitoring respiratory conditions

Fukuyama, concensus statement of FS1996.
Protocol Diazepam infusion
for refractory status epilepticus
Diazepam 50 mg is diluted in a solution of 250
ml 0,9% NaCl or D5W and run as a continuous
infusion (2 mg/kg/h)

Medical college of Virginia status epilepticus in children
Continuous Midazolam Infusion
Pediatric Studies
Initial bolus : 150 200 ug /kg IV
Drip rate : 1 10 ug/kg/min
(2-5 typical)
Phenobarbital : 20 mg/kg IV over 10-20 min
AOCCN, CEBU 2007
3
Intravenous Phenytoin
Doses : 15-20 mg/kg

Should be given slowly by intravenous drip infusion over
20 min while monitoring closely for arrhythmia or any
decrease in blood pressure.

Fukuyama, consensus statement of FS,1996.
5
Table 1 : Emergency department anticonvulsants
guideline CPS 2003
LONGER-ACTING ANTICONVULSANTS / ACUTE CESSATION AND PREVENTION
Phenytoin*
(IV,IQ)
20 mg/kg
1000 mg
(30 mg/kg)
1 mg/kg/min
May give
additional 5
mg/kg IV if
unable to
stop seizure
Hypotension,
arrtythmia, need to
be on cardiac
monitor
Must be given in non
glucosecontaining
solution
Phenobarbital*
(IV,10)
20
mg/kg
600 mg
(30 mg/kg)
1 mg/kg/
min
First choice in
neonates
Respiratory
depression,
especially if
Valium has been
used
Drug and Route Dose Max Risks Rate Repeat Comments
6
Table 1 : Emergency department anticonvulsants
guideline CPS2003
Drug and
Route
SHORTER TERM / ACUTE CESSATION OF SEIZURE
Dose Max Rate Repeat Risks Comments
Diazepam
(PR)
0.5
mg/kg
10 mg q5-10 min

Use undiluted IV
preparation
Diazepam
(IV,IO)
0.3
mg/kg
10 mg
< 2
mg/min
q5min x
2-3
Administrator as
close to vein as
possible without
dilution
7
Protokol Pengunaan Midazolam pada
Refrakter SE
Rawat di ICU, intubasi dan berikan ventilasi
Midazolam bolus 0.2 mg/kg (perlahan), kemudian
drip 0,02-0,4 mg/kg/hr
Rumatan fenitoin dan fenobarbital tetap diberikan
Dosis midazolam diturunkan bila terdapat gangguan
kardiovaskuler.
Infus di tapering bila 12 jam tidak terlihat kejang.

PENANGANAN KEJANG & KONVULSIF STATUS EPILEPTICUS
(UKK2006)
Diazepam 5-10mg rektal
( max 2x , jarak 5 menit)

Prehospital
Airway
Breathing
Circulation
Diazepam 0,25-0,5mg/kg/iv
(rate 2mg/min, max dose 10mg)
Midazolam 0,2mg/kg/iv/im
atau
atau
10-20min
Phenytoin
20mg/kg/iv
(>20min /50ml NS)

Phenobarbital

60-90min
20mg/kg/iv(rate >10min;
Hospital/ED
Lorazepam 0,05-0,1mg/kg/iv
(rate <2mg/min)
0-10min
20-30min ICU/ED
ICU Refracter SE
Refractory Status Epilepticus*
Midazolam 0.2 mg/kg IV, follow by 0.02-0.4 mg/kg/hr
ventilatory support

*Best managed in the pediatric intensive care unit
Midazolam IM
Diazepam IV 20 mg sama efektifnya dengan
midazolam 15 mg IM
Pasien dengan status epileptikus: Kejang berhenti
setelah 2-3 menit

Wasterlain, CG. Status epilepticus, 2006
Thiele, EA. Treatment of pediatric neurology, 2005
Freedman, SB. Clin Pediatric Emergency Medicine, 2003

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