PARALDEHYDE

Paraldehyde

Reviewed by  Dr  Malcolm Battin, Brenda Hughes, Gail Glogoski,  Robyn Wilkinson.
August 1999
May 2000 (administration details only)
Dose and Pharmacology Newborn Drug Protocol Index Newborn Services Home Page

Management of Paraldehyde Administration

Description

NB: The reference for paraldehyde 2 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:

Rectal enema:

Administration

Slow Intravenous Infusion over 2 hours (preferred method).

  1. Dilute paraldehyde immediately prior to use.
  2. 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).
  3. Connect a Gemini Administration Set 2260 (for Nitroglycerin and Fat Emulsions) to the PAB.
  4. 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).
  5. 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.
  6. Incompatible with everything but sodium chloride 0.9%. Do NOT mix with other drugs, IV solutions, blood or blood products.
  7. Flush line with sodium chloride 0.9% before and after infusion of paraldehyde.

Rectal Enema

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

Observation and Documentation

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

Storage

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. (31st 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 (6th ed.) Pharmacy Dept. Royal Liverpool Children’s Hospital (Alder Hey); 1994 (with 1996 amendments): Liverpool.