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High-dose lorazepam therapy for status epilepticus in a pediatric patient
H M Reincke1, R L Gilmore, R J Kuhn
1Department of Neurology, College of Medicine, University of Kentucky Medical Center, Lexington 40536.
Insights
High-dose lorazepam effectively managed status epilepticus in a patient with chronic benzodiazepine use. Tolerance may have prevented respiratory depression, suggesting aggressive dosing is viable for such cases.
Area of Science:
- Neurology
- Pharmacology
Background:
- Status epilepticus requires prompt and effective treatment.
- Benzodiazepines are first-line agents for status epilepticus.
- Chronic benzodiazepine therapy can lead to tolerance.
Observation:
- A 14-year-old patient with intractable seizures received high-dose lorazepam for status epilepticus.
- The patient was on chronic oral clonazepam therapy.
- No respiratory depression occurred despite high lorazepam dosage.
Findings:
- Extraordinarily high-dose lorazepam was managed without respiratory depression.
- Potential benzodiazepine-receptor down-regulation due to chronic clonazepam may explain the lack of adverse effects.
- Aggressive benzodiazepine dosing may be necessary in patients with prior benzodiazepine exposure.
Implications:
- This case suggests that tolerance to benzodiazepines can mitigate respiratory depression risks.
- Clinicians should consider prior benzodiazepine exposure when dosing for status epilepticus.
- Further research into dose escalation protocols for benzodiazepine-tolerant patients is warranted.
Abstract:
This report details the management of status epilepticus with high-dose lorazepam in a 14-year-old patient who was receiving oral clonazepam, ethosuximide, and phenobarbital for an intractable seizure disorder. Although respiratory depression is a frequently cited potential complication of therapy, it did not occur in this patient despite an extraordinarily high total dose of lorazepam, possibly because of tolerance associated with benzodiazepine-receptor down-regulation in this patient's chronic clonazepam therapy. Aggressive dosing of a benzodiazepine may be required for patients receiving chronic benzodiazepine therapy.