## First-Line Benzodiazepine Dosing in Pediatric Status Epilepticus **Key Point:** Intravenous lorazepam is the preferred first-line benzodiazepine for acute seizure management in children, with a dose of **0.1 mg/kg IV, maximum 4 mg per dose**. **High-Yield:** The standard protocol for status epilepticus in children follows a time-based approach: | Time Phase | Agent | Dose | Route | |---|---|---|---| | 0–5 min (First-line) | Lorazepam | 0.1 mg/kg (max 4 mg) | IV | | 0–5 min (Alternative) | Diazepam | 0.2 mg/kg (max 10 mg) | IV/PR | | 5–20 min (Second-line) | Fosphenytoin or Levetiracetam | Weight-based | IV | | >20 min (Refractory) | Propofol or Midazolam infusion | Titrated | IV | **Clinical Pearl:** Lorazepam has a longer duration of action (12–24 hours) compared to diazepam (15–60 minutes), making it superior for sustained seizure control and reducing the risk of seizure recurrence. **Mnemonic:** **LORAZ-4** — Lorazepam 0.1 mg/kg, maximum **4 mg** per dose. This distinguishes it from diazepam (0.2 mg/kg, max 10 mg). **Warning:** Doses exceeding 4 mg per single IV push increase the risk of respiratory depression and apnea, particularly in infants and young children. Always have airway equipment at bedside.
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