Supportive care
Establish IV/IO access
Check blood glucose
If fever, acetaminophen 15 mg/kg rectally
Benzodiazepine: first dose
IV/IO access establised
Lorazepam 0.1 mg/kg IV or IO (max = 4 mg), OR
Diazepam 0.2 mg/kg IV or IO, (max = 8 mg)
IV or IO access not achieved within 3 minutes:
Buccal midazolam 0.2 mg/kg (max = 10 mg), OR
IM  midazolam 0.1 to 0.2 mg/kg (max = 10 mg), OR
Rectal diazepam (Diastat gel or injection solution given rectally) 0.5 mg/kg (max = 20 mg)
IV/IO access establised
Lorazepam 0.1 mg/kg IV or IO (max = 4 mg), OR
Diazepam 0.2 mg/kg IV or IO, (max = 8 mg)
IV or IO access not achieved within 3 minutes:
Buccal midazolam 0.2 mg/kg (max = 10 mg), OR
IM  midazolam 0.1 to 0.2 mg/kg (max = 10 mg), OR
Rectal diazepam (Diastat gel or injection solution given rectally) 0.5 mg/kg (max = 20 mg)
Lorazepam 0.1 mg/kg IV or IO (max = 4 mg), OR
Diazepam 0.2 mg/kg IV or IO, (max = 8 mg)
Buccal midazolam 0.2 mg/kg (max = 10 mg), OR
IM  midazolam 0.1 to 0.2 mg/kg (max = 10 mg), OR
Rectal diazepam (Diastat gel or injection solution given rectally) 0.5 mg/kg (max = 20 mg)
Give antibiotics if signs of sepsis or meningitis
POC electrolytes, if available
Benzodiazepine: second dose
Antiepileptic: first therapy
Levetiracetam 40 mg/kg IV or IO, OR
Fosphenytoin^ 20 mg PE per kg IV or IO§, OR
Valproate  20 to 40 mg/kg IV or IO, OR
Phenobarbital 20 mg/kg IV or IO, maximum 1 g, (expect respiratory depression with apnea)¥
Levetiracetam 40 mg/kg IV or IO, OR
Fosphenytoin^ 20 mg PE per kg IV or IO§, OR
Valproate  20 to 40 mg/kg IV or IO, OR
Phenobarbital 20 mg/kg IV or IO, maximum 1 g, (expect respiratory depression with apnea)¥
Consider intubation, if not already performed
Pediatric neurology consultation
Antiepileptic: second therapy
Fosphenytoin^ (if not already given) 20 mg PE per kg IV or IO, OR
Valproate (if not already given) 20 to 40 mg/kg IV or IO, OR
Phenobarbital (if not already given) 20 mg/kg IV or IO, (max = 1 g; 10 mg/kg if phenobarbital already given), OR
Levetiracetam (if not already given) 40 mg/kg IV or IO,
If isoniazid toxicity suspected, pyridoxine
Infants (<1 year): 100 mg IV or IO in
Otherwise 70 mg/kg IV or IO (max = 5 g)
Fosphenytoin^ (if not already given) 20 mg PE per kg IV or IO, OR
Valproate (if not already given) 20 to 40 mg/kg IV or IO, OR
Phenobarbital (if not already given) 20 mg/kg IV or IO, (max = 1 g; 10 mg/kg if phenobarbital already given), OR
Levetiracetam (if not already given) 40 mg/kg IV or IO,
Infants (<1 year): 100 mg IV or IO in
Otherwise 70 mg/kg IV or IO (max = 5 g)
^May be ineffective for toxin-induced seizures and contraindicated in cocaine toxicity
Treat underlying infection if indicated
See pediatric fever of uncertain source
See pediatric fever of uncertain source
Febrile seizure
Epileptic seizure
Status epilepticus
First-time seizure
Seizure 
Seizure with known seizure disorder
Seizure
Psychogenic nonepileptic seizure