12/28/2022 0 Comments Rectal diazepam antidote![]() (Rectal diazepam is not an ideal means of treating status epilepticus out of hospital and parents/carers should be discouraged from giving repeated doses at short intervals, which will increase the possibility of life-threatening respiratory depression). Rectal diazepam may be given at home before transport to hospital. Patient has a history of spontaneous status epilepticus and diazepam has been shown to be effective in previous episodes.Patient tends to have `clusters' of seizures and oral therapy is not appropriate.If there is no response within 10 minutes of administration, the child should be urgently transported to hospital. Patient has a pattern of prolonged seizures (>10 minutes) which have previously responded to intravenous or rectal diazepam.It is reasonable to consider prescribing rectal diazepam for home use in the following situations. The recommended dose for children is 0.5 mg/kg up to 10 mg. Guidelines for home use of rectal diazepam in children* Diazepam given rectally appears to be as effective as intravenous diazepam in terminating seizures. ![]() Guidelines and indications for the home use of rectal diazepam in children by non-medical people are listed in Table 1.Įxperience suggests that rectal diazepam is rapidly effective in children, but efficacy has not been well studied in adults. In the emergency department of the Royal Children's Hospital, Melbourne, rectal diazepam is often given instead of intravenous diazepam for prolonged convulsions when intravenous access cannot be obtained. Rectal diazepam can be given by a treating doctor when intravenous access cannot readily be obtained, as is often the case in infants and toddlers. Rectal administration of the intravenous form of diazepam has been used successfully for hospital and home treatment of prolonged seizures. Suppositories have slow and variable absorption rates and are not recommended in an emergency. Intramuscular diazepam has similar absorption problems, is painful and may cause muscle necrosis. The absorption of oral diazepam is slow (1-2 hours) and variable. The concentrations in the brain and serum fall rapidly. Unfortunately, this pharmacokinetic profile means diazepam is quickly redistributed to other fatty tissues. The lipid solubility of diazepam allows it to enter the brain readily and terminate seizures quickly. Intravenous diazepam may be difficult to administer to the young convulsing child and, because of the need for intravenous access, is not ideal for rapid treatment in the community by non-medical carers. Diazepam or clonazepam, given intravenously, is generally the drug of choice for the emergency treatment of convulsive status epilepticus. ![]() 1 Convulsive seizures lasting longer than 30 minutes constitute status epilepticus and may be complicated by cardio respiratory depression and brain injury. Similarly, the efficacy of anticonvulsant medication decreases after 10-15 minutes of fitting and the risk of adverse effects increases. The chance of a seizure stopping spontaneously decreases significantly after 10-15 minutes. Seizures in children usually cease spontaneously within 5-10 minutes and are rarely associated with significant sequelae. ![]()
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