Child status: IV lorazepam 🚨 👶
🚨 👶 PAEDIATRIC HIGH ALERT — EDUCATIONAL DRAFT, NOT A PRESCRIBING ORDER. Drug choice, indication, formulation, dose, route and monitoring require current BNF/BNFC, product SmPC and local NHS protocol. Source reviewed 3 November 2026; independent clinical/pharmacy sign-off pending.
🧬 Mechanism and reason for use
- Lorazepam enhances GABA-A inhibition and is a first-line antiseizure benzodiazepine for ongoing convulsive status epilepticus when IV/IO access and resuscitation facilities are available.
- Convulsive seizure at or beyond 5 minutes, after immediate ABCDE, glucose measurement and checking any individual rescue plan.
💊 Indication-specific UK regimen / dosing boundary
- RCUK 2025 paediatric status algorithm: lorazepam 0.1 mg/kg IV or IO (maximum 4 mg per dose); may give a second dose at the 10-minute reassessment point following algorithm.
- Count all doses of benzodiazepines already given (ambulance/home included); usually no more than two doses before second-line treatment under paediatric specialist direction.
- Neonates and specialised conditions require dedicated protocols, not extrapolation.
🔎 Before writing a prescription
- Check current weight, 5-minute seizure timing, prior rescue medicines, respiratory support/equipment and prescribed dilution/route.
🧪 Monitoring and reassessment
- Airway, respiratory rate, SpO₂, ECG, ongoing seizure activity, blood glucose, blood pressure; request PICU/anaesthetic help early for refractory seizure.
🚨 Serious pitfalls / when to escalate
- Excess benzodiazepine doses cause apnoea; do not delay second-line treatment by giving repeated uncounted doses.
📖 UK reference documents
Editorial status: Source checked for the specific statements above on 3 November 2026. References may be updated. This card has not had formal independent pharmacist/consultant approval; no unlisted indications, paediatric extrapolation or automatic renal-dose adjustments are implied.
