Diazepam Administration for Active Seizures in Pediatric Patients
Introduction to Diazepam Administration
- The American Academy of Pediatrics recommends administering IV diazepam 0.2-0.5 mg/kg (maximum 5 mg for children under 5 years; maximum 10 mg for children 5 years and older) slowly over 2 minutes, repeating every 2-5 minutes as needed up to the maximum dose, followed immediately by a long-acting anticonvulsant to prevent seizure recurrence 1
When to Give Diazepam
- Administer diazepam immediately for active tonic-clonic seizures (status epilepticus) lasting beyond 5 minutes 1
Dosing by Age and Route
- For infants over 30 days and children under 5 years, administer 0.2-0.5 mg/kg IV slowly every 2-5 minutes, with a maximum total dose of 5 mg, over approximately 2 minutes to avoid pain at the IV site 1
- An alternative dosing range is 0.1-0.3 mg/kg IV every 5-10 minutes (maximum 10 mg per dose) 1
- When IV access cannot be established, administer 0.5 mg/kg rectally, up to a maximum of 20 mg 1
Critical Safety Considerations
- Monitor oxygen saturation continuously and have respiratory support immediately available 1
- Increased risk of apnea when given rapidly IV or combined with other sedatives 1
Subsequent Management
- If seizures persist after maximum diazepam dose, immediately administer long-acting anticonvulsant (phenytoin or fosphenytoin) 1
- Monitor for seizure recurrence for at least 2 hours after initial administration 2
- Flumazenil may reverse life-threatening respiratory depression, but will also counteract anticonvulsant effects and may precipitate seizures 1
- Never use flumazenil simply to reverse sedation in seizure patients 2