Management of Paraldehyde Administration

Description

Paraldehyde injection is a colourless or pale yellow transparent liquid with a strong characteristic odour.
It contains hydroquinone as an antioxidant – this is a non-therapeutic additive.
It is available in 5 ml ampoules.

NB:

The reference for paraldehyde² gives a dose range of 0.2 to 0.4 g/kg every 24 hours. Paraldehyde injection is NOT a weight/volume preparation i.e. it is pure paraldehyde liquid. We must therefore make an assumption that the researchers for this article used the relative density of paraldehyde as a reference for the g/kg dose. The relative density of paraldehyde is 0.996 ⁶ i.e. 1g=1ml and 0.2g=0.2ml.

Prescription

Slow intravenous infusion

Charted under continuous drugs on the Level 3 Infant Drug Administration Record, giving:

amount of drug
base fluid, type and volume
rate in ml/hour
total amount to be infused
ml/kg/dose

Rectal enema:

Stat dose to be charted on stat page of prescription chart in ml/dose

Administration

Slow Intravenous Infusion over 2 hours (preferred method).

Dilute paraldehyde immediately prior to use.
Make a 5% solution. Using a glass syringe to draw up the paraldehyde:
1. Add 2.5ml Paraldehyde to
2. 47.5ml Sodium chloride 0.9%
3. Giving 50.0ml total volume to an empty McGaw Partial Additive Bag (PAB).
Connect a Gemini Administration Set 2260 (for Nitroglycerin and Fat Emulsions) to the PAB.
Administer through a Gemini PCI Volumetric Infusion Pump over 2 hours (4-8 ml/kg, of diluted paraldehyde i.e. 5% solution) directly into cannula (Do not use minibore extension).
Diluted paraldehyde must be administered via bag and tubing made of polyethylene or polypropylene but not polyvinyl chloride. Never use through a 3-way stopcock. Cover tubing with tinfoil to protect from light.
Incompatible with everything but sodium chloride 0.9%. Do NOT mix with other drugs, IV solutions, blood or blood products.
Flush line with sodium chloride 0.9% before and after infusion of paraldehyde.

Rectal Enema

Dilute before administration with an equal volume of olive oil ⁸.

Observation and Documentation

The baby is attached to a continuous cardiac respiratory monitor and managed by a nurse with Neonatal IV Drug Certification.
Document heart rate, respiratory rate, and blood pressure hourly while infusion is in progress.
Observe for and document seizure activity.
Observe for decreased urinary output.

Storage

Unopened - store at room temperature <25°C.
Discard in a sharps container in a non-clinical area after use (unpleasant odour).

Selected References

1	Giacoia GP, Gessner PK, Zaleska MM, Boutwel WC. Pharmacokinetics of paraldehyde disposition in the neonate. J Pediatr 1984; 104: 291-296.
2	Koren G, Butt W, Rachjot P et al. Intravenous paraldehyde for seizure control in newborn infants. Neurology 1986; 36: 108-11.
3	Bostom B. Paraldehyde toxicity during treatment of status epilepticus. Am J Child 1982; 136: 414-415.
4	Evans D, Levene M. Neonatal seizures. Arch Dis Child Fetal Neonatal Ed. 1998;78:F70-75
5	Paraldehyde Data Sheet. DBL Ltd.; 1993: Mulgrave.
6	Reynolds JEF (Ed.) Martindale: The Extra Pharmacopoeia. (31^st ed). Royal Pharmaceutical Society; 1996: London
7	McEvoy GK (Ed.) AHFS 98 Drug Information. American Society of Health-System Pharmacists; 1998: Bethesda
8	Loe E. et al. Paediatric Pharmacopoeia, Royal Children’s Hospital Melbourne and Leicester Royal Infirmary Children’s Hospital. WB Saunders Co. Ltd; 1998: London
9	Alder Hey Book of Children’s Doses (6^th ed.) Pharmacy Dept. Royal Liverpool Children’s Hospital (Alder Hey); 1994 (with 1996 amendments): Liverpool.