Acute seizure termination
›First line benzodiazepines
›Lorazepam IV
›0.1 mg/kg
›Maximum 4 mg per dose
›Repeat once after 5 minutes if ongoing seizure
›Respiratory depression monitoring
›Diazepam IV
›0.2 mg/kg
›Maximum 10 mg per dose
›Repeat once after 5 minutes if ongoing seizure
›Respiratory depression monitoring
›Midazolam intranasal
›0.2 mg/kg
›Maximum 10 mg per dose
›Repeat once after 5 minutes if ongoing seizure
›Ventilation monitoring
›Midazolam IM
›0.2 mg/kg
›Maximum 10 mg per dose
›Repeat once after 5 minutes if ongoing seizure
›Hypotension monitoring
›Second line antiseizure therapy for refractory seizures
›Levetiracetam IV
›60 mg/kg
›Maximum 4500 mg
›Infusion time per local protocol
›Monitoring for agitation
›Fosphenytoin IV
›20 mg PE/kg
›Maximum 1500 mg PE
›If persistent seizure, additional 5 to 10 mg PE/kg
›Cardiac monitoring
›Valproate IV
›40 mg/kg
›Maximum 3000 mg
›Avoid known mitochondrial disease
›Avoid significant hepatic disease
›Phenobarbital IV
›20 mg/kg
›Respiratory depression monitoring
›Refractory status pathway
›If ongoing convulsions after second line agent, ICU escalation
›Continuous infusion pathway per institutional protocol
›Antipyretics for comfort
›Acetaminophen PO
›15 mg/kg
›Every 4 to 6 hours as needed
›Ibuprofen PO
›10 mg/kg
›Every 6 to 8 hours as needed
›Avoid dehydration with renal risk
›Counseling on recurrence prevention limits
›Antipyretics do not reliably prevent febrile seizure recurrence
›Comfort benefit only
›No routine daily antiseizure prophylaxis for simple febrile seizure
›Adverse effects outweigh benefit
›Education and reassurance preferred
›Intermittent rescue medication
›Consideration for recurrent prolonged febrile seizures based on clinician judgment
›Rectal diazepam or intranasal midazolam prescription pathways