Active Seizure & Drug Volumes by Weight
Active Seizure Guideline
Author: ETAT-SA Working Group
Editor: Dr Baljit Cheema
This convulsion protocol is adapted from the Emergency Treatment Assessment & Triage S Africa (ETAT-SA) Manual 2013
Active Seizure Algorithm
Table 1: Dose of Phenobarbitone for neonates < 28 days
Table 2: Emergency treatment of convulsions – volumes of drugs given by weight: Lorazepam / Midazolam / Diazepam
Table 3: Emergency treatment of convulsions - volumes of drugs given by weight: Phenobarbitone & Phenytoin
Active Seizure Algorithm
Click on image to enlarge
Table 1: Dose of Phenobarbitone for neonates < 28 days.
Note: AVOID BENZODIAZEPINES – high risk of apnoea!
| Weight of infant | 2 kg or less | 3 kg |
| Initial dose of Phenobarbitone, 20 mg/kg, 200 mg/ml solution | 0.2 ml | 0.3 ml |
| If convulsions continue after 30 mins, give another dose at 10 mg/kg | 0.1 ml | 0.15 ml |
Table 2: Emergency treatment of convulsions – volumes of drugs given by weight: Lorazepam / Midazolam / Diazepam
LORAZEPAM
| WEIGHT | LORAZEPAM 4mg/ml ampoule | |
| Buccal 0.1mg/kg Volume = 0.025ml/kg | IV 0.1mg/kg Volume = 0.025ml/kg | |
| 4 kg | 0.1 ml | 0.1 ml |
| 5 -6 kg | 0.15 ml | 0.15 ml |
| 7 - 8 kg | 0.2 ml | 0.2 ml |
| 9 -10kg | 0.25 ml | 0.25 ml |
| 11 - 12kg | 0.3 ml | 0.3 ml |
| 13 -14kg | 0.35 ml | 0.35 ml |
| 15 -16kg | 0.4 ml | 0.4 ml |
| 17 -18kg | 0.45 ml | 0.45 ml |
| 19 - 20kg | 0.5 ml | 0.5 ml |
MIDAZOLAM
IMPORTANT NOTE: Midazolam comes in two strengths:
5mg/5ml = 1mg in 1ml or 15mg/3ml = 5mg in 1ml (best for buccal as smaller volume)
PLEASE CHECK WHICH STRENGTH YOU ARE USING
then draw up the correct volume using the chart below
| WEIGHT | MIDAZOLAM 5mg/5ml ampoule (i.e. 1mg /1ml) | MIDAZOLAM 15mg/3ml ampoule (i.e. 5mg/1 ml) | |
| IV 0.25mg/kg Volume = 0.25ml/kg | Buccal 0.5mg/kg Volume = 0.1ml/kg | IV 0.25mg/kg Volume = 0.25ml/kg | |
| < 4 kg | - | 0.4 ml | 0.2 ml |
| 4kg | 1.0 ml | 0.6 ml | 0.3 ml |
| 5kg | 1.3 ml | ||
| 6kg | 1.5 ml | ||
| 7kg | 1.8 ml | 0.8 ml | 0.4 ml |
| 8kg | 2.0 ml | ||
| 9kg | 2.3 ml | 1.0 ml | 0.5 ml |
| 10kg | 2.5 ml | ||
| 11kg | 2.8 ml | 1.2 ml | 0.6 ml |
| 12kg | 3.0 ml | ||
| 13kg | 3.3 ml | 1.4 ml | 0.7 ml |
| 14kg | 3.5 ml | ||
| 15kg | 3.8 ml | 1.6 ml | 0.8 ml |
| 16kg | 4.0 ml | ||
| 17kg | 4.3 ml | 1.8 ml | 0.9 ml |
| 18kg | 4.5 ml | ||
| 19kg | 4.8 ml | 2.0 ml | 1.0 ml |
| 20kg | 5.0 ml | ||
DIAZEPAM
| WEIGHT | DIAZEPAM 10mg/2ml ampoule | |
| Per Rectum 0.5mg/kg Volume = 0.1ml/kg | IV 0.25mg/kg Volume = 0.05ml/kg | |
| 4kg | 0.4 ml | 0.20 ml |
| 5kg | 0.5 ml | 0.25 ml |
| 6kg | 0.6 ml | 0.30 ml |
| 7kg | 0.7 ml | 0.35 ml |
| 8kg | 0.8 ml | 0.40 ml |
| 9kg | 0.9 ml | 0.45 ml |
| 10kg | 1.0 ml | 0.50 ml |
| 11kg | 1.1 ml | 0.55 ml |
| 12kg | 1.2 ml | 0.60 ml |
| 13kg | 1.3 ml | 0.65 ml |
| 14kg | 1.4 ml | 0.70 ml |
| 15kg | 1.5 ml | 0.75 ml |
| 16kg | 1.6 ml | 0.80 ml |
| 17kg | 1.7 ml | 0.85 ml |
| 18kg | 1.8 ml | 0.90 ml |
| 19kg | 1.9 ml | 0.95 ml |
| 20kg | 2.0 ml | 1.00 ml |
Table 3: Emergency treatment of convulsions - volumes of drugs given by weight: Phenobarbitone and Phenytoin
PHENOBARBITONE
| WEIGHT | PHENOBARBITONE 200mg/ml ampoule | |
| 1st Dose 20mg/kg IV or IM Volume = 0.1ml/kg | 2nd Dose 10mg/kg IV or IM Volume = 0.05ml/kg | |
| 4kg | 0.4 ml | 0.20 ml |
| 5kg | 0.5 ml | 0.25 ml |
| 6kg | 0.6 ml | 0.30 ml |
| 7kg | 0.7 ml | 0.35 ml |
| 8kg | 0.8 ml | 0.40 ml |
| 9kg | 0.9 ml | 0.45 ml |
| 10kg | 1.0 ml | 0.50 ml |
| 11kg | 1.1 ml | 0.55 ml |
| 12kg | 1.2 ml | 0.60 ml |
| 13kg | 1.3 ml | 0.65 ml |
| 14kg | 1.4 ml | 0.70 ml |
| 15kg | 1.5 ml | 0.75 ml |
| 16kg | 1.6 ml | 0.80 ml |
| 17kg | 1.7 ml | 0.85 ml |
| 18kg | 1.8 ml | 0.90 ml |
| 19kg | 1.9 ml | 0.95 ml |
| 20kg | 2.0 ml | 1.00 ml |
PHENYTOIN
| WEIGHT | PHENYTOIN* 250mg/5ml ampoule |
| Dose = 20mg/kg Give ONCE only, mix in 50ml 0.9% Normal Saline and infuse slowly over 30 minutes under ECG control** (Do NOT mix with Dextrose/Glucose ) | |
| 4kg | 1.6 ml |
| 5kg | 2.0 ml |
| 6kg | 2.4 ml |
| 7kg | 2.8 ml |
| 8kg | 3.2 ml |
| 9kg | 3.6 ml |
| 10kg | 4.0 ml |
| 11kg | 4.4 ml |
| 12kg | 4.8 ml |
| 13kg | 5.2 ml |
| 14kg | 5.6 ml |
| 15kg | 6.0 ml |
| 16kg | 6.4 ml |
| 17kg | 6.8 ml |
| 18kg | 7.2 ml |
| 19kg | 7.6 ml |
| 20kg | 8.0 ml |
*Monitor for bradycardia and arrhythmias and hypotension - if so stop the infusion until stable then restart to give over 1 hour.
**For small babies, reduce the volume of Normal Saline used for mixing
Acknowledgement/References:
- The drug volume calculation tables taken from the ETAT-SA manual (2013)