Diazepam intravenous

Give a BZD, such as diazepam, 5 to 10 mg orally every 1 to 2 hours, as needed for sedation, with a maximum of 80 to 100 mg per day. If the patient is severely agitated, give 5 to 10 mg diazepam intravenously slowly every 20 minutes, until the patient is sedated. 

J. Lopez-Herce, et al., Alcohol poisoning following diazepam intravenous infusion. Ann Pharmacol. Ther. 29 632, 1995. 

Lopez-Herce J, Bonet C, Meana A, Albajara L. Benzyl alcohol poisoning following diazepam intravenous infusion [letter]. Ann Pharmacother 1995 29 632. 

Undesirably prolonged erections (duration of 5 and 6 hours) occurred in 2 patients who had been given 5 or 10 mg of diazepam intravenously for anxiety before a 60-mg intracavemosal injection of papaverine. Papaverine acts by relaxing the arterioles that supply the corpora so that the pressure rises. The increased pressure in the corpora compresses the trabecular venules so that the pressure continues to maintain the erection. Diazepam also relaxes smooth muscle and it would seem that this can be additive with the effects of papaverine. The authors of the report say that caution should be exercised in the choice of papaverine dosage in patients taking anxiolytics (i.e. use less) although tiiese two cases involving diazepam seem to be the only ones recorded. ... 

CifiHijClNj. White plates m.p. 125 C. Diazepam is one of several benzodiazepines which are very widely used as minor tranquillizers for allaying anxiety, as hypnotics or, in sufficiently high dosage given intravenously, as pre-anaesthetic sedatives. 

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... 

Metabolic Effects. Severe metabolic acidosis with high anion gap and hyperglycemia was reported in humans after acute poisoning with endosulfan (Blanco-Coronado et al. 1992 Lo et al. 1995). In five of the six cases reported by Blanco-Coronado et al. (1992), the metabolic acidosis was corrected with gastric lavage with activated charcoal and intravenous sodium bicarbonate and diazepam. No further information regarding metabolic effects in humans after exposure to endosulfan was located. 

The first-line treatment for status epilepticus is intravenous benzodiazepines. Diazepam, lorazepam, or midazolam may be used to rapidly control clinical signs of seizures. Lorazepam is currently considered the first-line agent by most clinicians. 

Midazolam Midazolam is water-soluble and can be administered intravenously, intramuscularly,13 buccally,14,15 and nasally.16,17 At physiologic pH, it becomes more lipophilic and can diffuse into the CNS. Compared to diazepam and lorazepam, it has fewer effects on the respiratory and cardiovascular systems. Its short half-life requires that it be re-dosed... 

I with seizures and require anticonvulsant therapy. Phenytoin is the most frequently used agent, with a loading dose of 15 mg/kg followed by 300 mg by mouth daily (titrated to therapeutic levels between 10 and 20 mcg/mL). Diazepam 5 mg intravenously may be used for rapid control of persistent seizures. Prophylactic anticonvulsants have been used frequently, but a recent meta-analysis did not support their use.23 Thus, because adverse effects and drug interactions are common, the routine use of prophylactic anticonvulsants is not recommended. 

Branch RA, Morgan MH, James J, Read AE Intravenous administration of diazepam in patients with chronic liver disease. Gut 1976 17 975-983. 

The answer is b. (Hardman, p 484. Katzung, p 415J Intravenous diazepam given immediately is highly effective in controlling status epilep-ticus. 

Q50 Intravenous midazolam is often preferred to intravenous diazepam as a sedative in combined anaesthesia. Midazolam is water-soluble and recovery is faster than from diazepam. 

Prolonged febrile convulsions can be treated by administration of diazepam (benzodiazepine) as a slow intravenous infusion or rectally. 

Diazepam, a long-acting benzodiazepine can be used either intravenously (risk of thrombophlebitis) or intramuscularly or rectally (both of the last two routes are associated with slow absorption). 

Diazepam may be used in status epilepticus where it is administered intravenously. However, there is a risk of thrombophlebitis. Diazepam has a long half-life and it is rapidly absorbed into the brain. 

Intravenously administered diazepam is first-line therapy for status epilepticus. However there is a serious risk for severe respiratory depression, hypotension, bradycardia and cardiac arrest. Rectal administration as micro-clysma can be an attractive alternative, especially in children. 

Management of methanol and ethylene glycol poisoning is similar. Symptomatic support of respiration and circulation is augmented by correction of metabolic acidosis with intravenous bicarbonate infusion, and control of seizures with diazepam. Ethanol inhibits the metabolism of methanol and ethylene glycol to the toxic metabolites, and can give time for further treatment. The goal is to maintain blood ethanol concentrations between 100 and 150 mg per decilitre, sufficient to saturate alcohol... 

Benzodiazepines are usually given orally and are well absorbed by this route. Since the benzodiazepines are weak bases, they are less ionized in the relatively alkaline environment of the small intestine, and therefore, most of their absorption takes place at this site. For emergency treatment of seizures or when used in anesthesia, the benzodiazepines also can be given parenter-ally. Diazepam and lorazepam are available for intravenous administration. 

Most BZs are completely absorbed from the gastrointestinal (GI) tract. The one exception is clorazepate, a pro-drug that undergoes acid hydrolysis in the stomach and is decarboxylated to form N-desmethyl-diazepam, which is then completely absorbed into the bloodstream (Bellantuono et ak, 1980 Hobbs et ak, 1996 Chouinard et ak, 1999). In contrast, most BZs, with the exception of lorazepam and midazolam, are not consistently absorbed from intramuscular injection (Chouinard et ak, 1999). Lorazepam is available as a sublingual form that reaches clinical effect at the same rate as an oral dose. In general, intravenous administration is used only for anesthesia or for the acute management of seizures. When BZs are given via this route, the onset of action is almost immediate (Chouinard et ak, 1999). 

Conscious sedation implies that patients have a depressed level of consciousness but nevertheless have intact protective reflexes, the ability to maintain their airway, and the ability to respond appropriately to requests and physical stimulation (Kennedy and Luh-mann, 1999). Sedative agents familiar to psychiatrists that are used in this manner for procedures include chloral hydrate, given orally or rectally in a dose of 25 to 100 mg/kg midazolam, given intramuscularly or intravenously in a dose of 0.05 to 0.15 mg/kg, rectally in a dose of 0.3 to 0.5 mg/kg, or orally in a dose of 0.2 to 0.75 mg/kg and midazolam, which is felt to be preferable to diazepam for this purpose (Kennedy and Luhmann, 1999). Midazolam is also available in a nasal spray (Ljungman et ah, 2000). 

Greenblatt DJ, Ehrenberg BL, Gunderman JS, et al. Pharmacokinetic and electroencephalographic study of intravenous diazepam, midazolam and placebo. Clin Pharmacol Ther 1989 45(4) 356-365. 

Hegarty JE, Dundee JW. Sequelae after the intravenous injection of three benzodiazepines—diazepam, lorazepam and flunitrazepam. BrMed J 1977 22 1384-1385. 

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