What is the typical initial lorazepam dose for benzodiazepine-refractory status epilepticus in adults?

• A. Diazepam 0.15 mg/kg IV
• B. Lorazepam 0.1 mg/kg IV (up to 4 mg per dose), may repeat once if seizures continue.
• C. Midazolam 5 mg IV
• D. Lorazepam 0.3 mg/kg IV

Answer: (B)

The important idea here is how lorazepam is dosed to rapidly control seizures in acute status epilepticus while keeping safety in mind. For adults, the standard initial IV dose is 0.1 mg/kg, with a maximum of 4 mg per dose, and it may be repeated once if seizures continue after that first dose. This weight-based approach delivers a swift benzodiazepine effect, and the option to repeat helps achieve seizure termination promptly before moving on to non-benzodiazepine anticonvulsants in a benzodiazepine-refractory situation. In practice, after two benzodiazepine doses without control, treatment shifts to second-line agents like phenytoin/fosphenytoin, valproate, or levetiracetam, and if the status remains refractory, to anesthetic therapy.