Diazepam for convulsions

Tenamfetamine ( ecstasy, MDMA methylenedioxymethamphetamine) is structurally related to mescaline as well as to amphetamine. It was originally patented in 1914 as an appetite suppressant and has recently achieved widespread popularity as a dance drug at rave parties (where it is deemed necessary to keep pace with the beat and duration of the music popular names reflect the appearance of the tablets and capsules and include White Dove, White Burger, Red and Black, Denis the Menace). Tenamfetamine stimulates central and peripheral a-and p-adrenoceptors thus the pharmacological effects are compounded by those of physical exertion, dehydration and heat. In susceptible individuals (poor metabolisers who exhibit the CYP450 2D6 polymorphism) a severe and fatal idiosyncratic reaction may occur with fulminant hyperthermia, convulsioirs, disseminated intravascular coagulation, rhabdomyolysis, and acute renal and hepatic failure. Treatment includes activated charcoal, diazepam for convulsions, P-blockade (atenolol) for tachycardia, a-blockade (phentolamine) for hypertension, and dantrolene if the rectal temperature exceeds 39°C. 

Overdose is common amongst users (up to 22% of heavy users report losing consciousness). The desired euphoria and excitement turns to acute fear, with psychotic symptoms, convulsions, hypertension, haemorrhagic storke, tachycardia, arrhythmias, hyperthermia coronary vasospasm (sufficient to present as the acute coronary syndrome with chest pain and myocardial infarction) may occur, and acute left ventricular dysfunction. Treatment is chosen according to the clinical picture (and the known mode of action), from amongst, e.g. haloperidol (rather than chlorpromazine) for mental disturbance diazepam for convulsions a vasodilator, e.g. a calcium channel blocker, for hypertension glyceryl trinitrate for myocardial ischaemia (but not a p-... 

Q18 The dose of diazepam for children in febrile convulsions is 250 pg/kg. What is the appropriate dose for a child v/eighing 25 kg ... 

When a child has febrile convulsions the decision to embark on continuous prophylaxis is serious for the child, and depends on an assessment of risk factors, e.g. age, nature and duration of the fits. Most children who have febrile convulsions do not develop epilepsy. Prolonged drug therapy, e.g. with phenytoin or phenobarbitone, has been shown to interfere with cognitive development, the effect persisting for months after the drug is withdrawn. Parents may be supplied with a specially formulated solution of diazepam for rectal administration (absorption from a suppository is too slow) for easy and early administration, and advised on managing fever, e.g. use paracetamol at the first hint of fever, and tepid sponging. 

Treatment is symptomatic and supportive, with diazepam for sedation if necessary. Cardiac monitoring is recommended in symptomatic cases. Coma and convulsions may occur in large overdose. If the patient presents within 2 h, a dose of activated charcoal should be given (50 g for adults lgkg for children). Observation of vital signs and neurological status for 6 h is recommended. 

Treatment - inhaling of aerosol mixtures with sodium bicarbonate - 3% solution and Novphyllin - stomach washing and intestine cleaning - in peroral intake of the poison - 10% Calcium gluconicum amp. 10 ml venally 3-4 times daily - benzodiazepine preparations - Diazepam ampoule 10 mg muscularly for convulsion incidents - oxygentherapy, respiratory reanimation and antishock preparations - applied by the established methods. 

Where nerve agent-induced convulsions are present, the standard intravenous dosage regime for diazepam for the treatment of convulsions is used ... 

In the scientific literature, there are many case report,s and serie,s of the apparently successful treatment of OP insecticide poisoning with diazepam as an adjunctive but widely accepted therapy (Karallicdde and Szinicz, 2001). Examples include Barckow et at. (1969), Vale and Scott (1974), Yacoub etal. (1981), Merrill and Mihm (1982), Marti etal. (1985). LeBlanc etal. (1986), de Kort etal. (1988), Jovanovic etal. (1990). Ku.sic etal. (1991), and Weissmann-Brenner et ai. (2002). In most ca.ses, the indication for the use of diazepam was convulsions, but diazepam has also been used to control muscle fascicu-lation and agitation. In the case of convulsions, the adult dose is 10-20 mg iv, whcrea.s that for children is 0.2 or 0,3 mg/kg iv. The elderly should receive half the adult dose. 

Up to three diazepam injectors may have to be used if the patient continues to have seizures. Wait 10 minutes between injections for convulsions to subside. Diazepam is a sedative, and once it has been given the patient must be monitored closely to be sure he or she does not hypoventilate. 

Chen L, Feng P, Wang J, Liu L, Zhou D. Intravenous sodium valproate in mainland China for the treatment of diazepam refractory convulsive status epilepticus. J Clin Neurosci 2009 16(4) 524-6. 

The nurse monitors the patient for signs and symptoms of acute salicylate toxicity or salicylism (see Display 17-1). Initial treatment includes induction of emesis or gastric lavage to remove any unabsorbed drug from the stomach. Activated charcoal diminishes salicylate absorption if given within 2 hours of ingestion. Further therapy is supportive (reduce hyperthermia and treat severe convulsions with diazepam). Hemodialysis is effective in removing Hie salicylate but is used only in patients with severe salicylism. 

Convulsions are treated with slow intravenous administration of diazepam (0.1—0.3 mg/kg for children 10 mg for adults) this treatment may be... 

CANA Convulsant Antidote for Nerve Agent, also called diazepam. 

Treatment — Patients should be decontaminated immediately prior to treatment using the decontamination method presented in Section 7.3.2. Ventilate the patient because of a possible increase in airway resistance due to constriction and the presence of secretions. If breathing is difficult, administer oxygen. Administer antidotes as soon as possible. The antidote for this agent is atropine alone or in combination with pralidoxime chloride (2-PAMC1) or another oxime. Diazepam may be required to control severe convulsions. 

There is no specific treatment for ingestion of ibotenic acid or muscimol rather, treatment is symptomatic and supportive. Anxiety, hysteria, or convulsions can be treated with sedatives, such as diazepam. This should be done cautiously, however, and with the lowest effective dose because animal studies revealed that respiratory arrest may occur. In severe cases, with prolonged nausea, vomiting, or diarrhea, monitoring of fluid and electrolyte status may be required. Recent cases of muscarine poisonings were reported by Benjamin (1992), and Tupalska-Wilczynska et al. (1997). 

Anticonvulsant As adjunctive therapy in the management of partial seizures (clorazepate) adjunctively in status epilepticus and severe recurrent convulsive seizures (diazepam IV) adjunctively in convulsive disorders (diazepam oral). Preoperative For preoperative apprehension and anxiety (chlordiazepoxide, diazepam IV) prior to cardioversion for the relief of anxiety and tension and to diminish patient s recall (diazepam IV) adjunctively prior to endoscopic procedures for apprehension, anxiety, or acute stress reactions and to diminish patient s recall (diazepam) ... 

Parenteral Adjunct in status epilepticus and severe recurrent convulsive seizures. Rectal For selected, refractory patients on stable regimens of anti-epileptic agents who require intermittent use of diazepam to control bouts of increased seizure activity. 

Convulsions associated with fever often occur in children 3 months to 5 years of age. Epilepsy later develops in approximately 2 to 3% of children who exhibit one or more such febrile seizures. Most authorities now recommend prophylactic treatment with anticonvulsant drugs only to patients at highest risk for development of epilepsy and for those who have multiple recurrent febrile seizures. Phenobarbital is the usual drug, although diazepam is also effective. Phenytoin and carba-mazepine are ineffective, and valproic acid may cause hepatotoxicity in very young patients. 

Given intravenously, both diazepam and midazolam are effective first-line treatments for status epilepticus. It is essential to be aware that the large doses that may be necessary to control convulsions are likely to cause respiratory depression and obtund protective reflexes. Oxygen and equipment suitable for its administration should be available. For intractable status epilepticus, clonazepam is a longer-acting alternative which can also be given by intravenous infusion. Overdosage... 

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