Status epilepticusRefer

• Lorazepam, Midazolam (no IV line), Diazepam (alternative)
• Second line (about 20 min): Levetiracetam, Phenytoin, Valproate (avoid in liver disease, under 2 y, and women who may become pregnant if another option exists)
• If glucose low: Thiamine, then Dextrose

• Still fitting at 40 min: Refractory — intubate; midazolam or propofol infusion in ICU with EEG (AES 2016, latest; NICE NG217 2026)

Treat the seizure first; tests run alongside, never before the first benzodiazepine.

First visit

• Capillary blood glucose — At once — treat a low glucose.
• Serum sodium, calcium, magnesium, creatinine — Correctable causes.
• CBC, blood gas — Infection and acidosis.
• Antiepileptic drug levels — Known epilepsy on phenytoin, valproate or carbamazepine.

Only if indicated

• CT/MRI brain — First seizure, focal signs, head injury, or not regaining consciousness.
• Lumbar puncture — Fever or neck stiffness (after imaging).
• Toxicology, pregnancy test — Unknown cause; women of child-bearing age (eclampsia).
• EEG — Not waking up (non-convulsive status).