tangent
06-28-02, 00:39
Tropical Doctor, July 1998
MEANS AND METHODS
Control of eclamptic convulsions with rectal diazepam
W G Povey MD FACOG
Eduarrlo Mondlane University Maputo, Mozambique
Tropical Doctor, 1998. 28. 175
INTRODUCTION
There is now compelling evidence that magnesium sulphate is the anticonvulsive drug of choice in the management of eclampsia. However, this drug is not available in many of the world's hospitals and birthing centres. Diazepam. the second drug of choice'. has many other uses and is therefore more widely available.
A further problem is that the control of prolonged convulsion requires intravenous (IV) administration of whatever drug is used. It is often impossible to access an IV line. particularly in obese or oedematous women. who are convulsing.
The use of rectal diazepam infusions in adult epilepsy is well established. Paediatricians use the technique regularly to control seizures in children(2,3). At Maputo Central Hospital we have many times used it to control eclamptic convulsion, following which it is possible to access a vein and to continue management with magnesium sulphate.
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Correspondence to: Department of Health Care and Epidemiol-ogy, University of British Columbia. Vancouver V6T IZ3. Canada
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Peak levels of diazepam have been shown to occur within 10 to 20 min ol rectal instillation, as compared with I to 24 h with intramuscular administration. Bioavailability by rectum is around 50% that of IV administration'.
TECHNIQUE
We use 20mg of the IV preparation of diazepam in a 10 ml syringe The needle is removed, the barrel is lubricated, and the syringe is inserted into the rectum for. half its length. The contents are discharged, the syringe is left in place, and the bullocks are held together (or 10 min to prevent expulsion of the drug. If convulsion is not controlled within 10 min an additional 10 tag is instilled. Alternatively, the drug can he injected into (lie rectum through a urinary catheter.
In circumstances in which IV administration is impossible or dangerous, as in a primary care unit that lacks the appropriate equipment or skills, we advise the rectal loading dose described above followed by an hourly rectal dose of at least 10 mg, depending upon the size of the woman and her clinical response. This method is invaluable when a patient must be transported for a long distance by human carriers, animal cart. or truck.
I The Eclampsia Trial Collaborative Group. Which anti-convulsant for eonnn with eclampsia? Lancet 1995:345: 1455-63
2 Sommerville ER. Antony JH. Position statement on the use of rectal diazepam in epilepsy. Med J Aust 1995;163:268 9 3 Berhman RE. Kliegman RM, Arvin AM. Nelson WE, gds. Nelson Textbook of Pediatrics, 15th edn. Philadelphia. WB Saunders 1996:1698
4 Magnussen 1, Oxlund HR. Alsbirk KE, Arnold E. Absorption of diazepam in man following rectal and parenteral administration. Acta Pharmacol Toxical 1979; 45:87-90
MEANS AND METHODS
Control of eclamptic convulsions with rectal diazepam
W G Povey MD FACOG
Eduarrlo Mondlane University Maputo, Mozambique
Tropical Doctor, 1998. 28. 175
INTRODUCTION
There is now compelling evidence that magnesium sulphate is the anticonvulsive drug of choice in the management of eclampsia. However, this drug is not available in many of the world's hospitals and birthing centres. Diazepam. the second drug of choice'. has many other uses and is therefore more widely available.
A further problem is that the control of prolonged convulsion requires intravenous (IV) administration of whatever drug is used. It is often impossible to access an IV line. particularly in obese or oedematous women. who are convulsing.
The use of rectal diazepam infusions in adult epilepsy is well established. Paediatricians use the technique regularly to control seizures in children(2,3). At Maputo Central Hospital we have many times used it to control eclamptic convulsion, following which it is possible to access a vein and to continue management with magnesium sulphate.
----------
Correspondence to: Department of Health Care and Epidemiol-ogy, University of British Columbia. Vancouver V6T IZ3. Canada
----------
Peak levels of diazepam have been shown to occur within 10 to 20 min ol rectal instillation, as compared with I to 24 h with intramuscular administration. Bioavailability by rectum is around 50% that of IV administration'.
TECHNIQUE
We use 20mg of the IV preparation of diazepam in a 10 ml syringe The needle is removed, the barrel is lubricated, and the syringe is inserted into the rectum for. half its length. The contents are discharged, the syringe is left in place, and the bullocks are held together (or 10 min to prevent expulsion of the drug. If convulsion is not controlled within 10 min an additional 10 tag is instilled. Alternatively, the drug can he injected into (lie rectum through a urinary catheter.
In circumstances in which IV administration is impossible or dangerous, as in a primary care unit that lacks the appropriate equipment or skills, we advise the rectal loading dose described above followed by an hourly rectal dose of at least 10 mg, depending upon the size of the woman and her clinical response. This method is invaluable when a patient must be transported for a long distance by human carriers, animal cart. or truck.
I The Eclampsia Trial Collaborative Group. Which anti-convulsant for eonnn with eclampsia? Lancet 1995:345: 1455-63
2 Sommerville ER. Antony JH. Position statement on the use of rectal diazepam in epilepsy. Med J Aust 1995;163:268 9 3 Berhman RE. Kliegman RM, Arvin AM. Nelson WE, gds. Nelson Textbook of Pediatrics, 15th edn. Philadelphia. WB Saunders 1996:1698
4 Magnussen 1, Oxlund HR. Alsbirk KE, Arnold E. Absorption of diazepam in man following rectal and parenteral administration. Acta Pharmacol Toxical 1979; 45:87-90