Episode 901: Underdosing in Status Epilepticus

Contributor: Aaron Lessen MD

Educational Pearls:

• Lorazepam (Ativan) is dosed at 0.1 mg/kg up to a maximum of 4 mg in status epilepticus

• Some ED protocols only give 2 mg initially

• The maximum recommended dose of levetiracetam (Keppra) is 60 mg/kg or 4.5 g

• In one retrospective study, only 50% of patients received the correct dose of lorazepam

• For levetiracetam, it was only 35% of patients

• Underdosing leads to complications

• Higher rates of intubations

• More likely to progress to refractory status epilepticus

References

1. Cetnarowski A, Cunningham B, Mullen C, Fowler M. Evaluation of intravenous lorazepam dosing strategies and the incidence of refractory status epilepticus. Epilepsy Res. 2023;190(November 2022):107067. doi:10.1016/j.eplepsyres.2022.107067

2. Sathe AG, Tillman H, Coles LD, et al. Underdosing of Benzodiazepines in Patients With Status Epilepticus Enrolled in Established Status Epilepticus Treatment Trial. Acad Emerg Med. 2019;26(8):940-943. doi:10.1111/acem.13811

Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit