What is the typical intranasal midazolam dose for pediatric seizure management in EMS?

• A. About 2 mg/kg.
• B. About 0.02 mg/kg.
• C. About 0.2 mg/kg (maximum around 5 mg per dose) administered intranasally.
• D. About 0.5 mg/kg.

Answer: (C)

Dosing intranasal midazolam in kids with seizures is about delivering a rapid, effective amount based on weight while keeping safety in mind. The typical dose is 0.2 mg per kilogram of body weight, with a maximum per dose of around 5 mg. This hits the sweet spot: it’s enough to stop many seizures quickly through the fast-acting nasal absorption, yet capped to minimize oversedation and airway risk in small children.

A dose like 2 mg/kg would be much too high and could lead to serious sedation and respiratory depression. A dose of 0.02 mg/kg is likely too small to control the seizure promptly. A dose of 0.5 mg/kg exceeds common single-dose recommendations and increases the chance of adverse effects. If the seizure continues, dosing can be repeated per protocol, always using the weight-based calculation and staying within the per-dose maximum.