Pediatric Seizure: Ketamine dose after Versed failure?

• A. 1 mg/kg IV/IO (Diluted)
• B. 0.5 mg/kg IV/IO
• C. 2 mg/kg IV/IO
• D. 1 mg/kg IN/IM

Answer: (A)

When a pediatric seizure doesn’t respond to benzodiazepines, ketamine is used as a rapid, second-line option because it blocks NMDA receptors and can halt ongoing seizure activity quickly. The recommended approach is a 1 mg/kg bolus given IV or IO, and it should be diluted for IV administration. Dilution allows a controlled, smooth push in small children and helps manage potential hemodynamic effects during the rapid onset. If seizures persist, additional dosing or a short infusion may be used, but starting with this diluted 1 mg/kg IV/IO bolus provides the most reliable, timely seizure control. Intranasal or intramuscular routes are less predictable in onset and reliability, so the IV/IO route is preferred in the acute setting.