Critical care, neurology and analgesia
Evelyne Jacqz-Aigrain, Imti Choonara in Paediatric Clinical Pharmacology, 2021
This is a major and important topic that cannot be dealt with thoroughly within this chapter [21]. The following medicines have all been shown to be effective in treating children with acute seizures: rectal diazepam, intravenous lorazepam and buccal midazolam. For children with intravenous access, lorazepam 100 microg/kg should be given intravenously; for those with no immediate intravenous access, the drug of first choice could be either rectal diazepam (500 microg/kg) or buccal midazolam (500 microg/kg). Lorazepam is considered to be more effective than diazepam and is associated with less respiratory depression [21–23]. Midazolam, administered by either the buccal or nasal route, has been shown to be effective in small prospective studies. Paraldehyde is a cheap and effective anticonvulsant for the child with an acute seizure and is best administered rectally. It can be administered intramuscularly, but there is a risk of sterile abscess formation.
Career Reflections
Peter Tate, Francesca Frame in Bedside Matters, 2020
By the time Ben arrived, Harold was getting even madder; he told me later that he was trapped in a living nightmare, genuinely dreaming, half-knowing it was dream but the demons were so real, and the irrationality was totally logical in a dreamscape world. He needed sedating, restraining and hospitalising. In those days I used paraldehyde by intramuscular injection. I had used it in similar circumstances while a ship's doctor. It is horrible stuff, must be used with a glass syringe as it dissolves plastic, and is a very painful injection with a high risk of causing abscess. But it is safe in the sense that it does not cause respiratory depression, can if necessary, as it was here, be injected straight through a tough pair of trousers, and is the most effective sedating agent I have ever used. Of course, no one ever uses it now. Ben agreed with the strategy and sat in his car while I got on with it; that is the hierarchy as it was. Although a big man, I was a bit nervous at that time that in any struggle my new pacemaker would be displaced, but sometimes you just had to get on with it. After a period of shadow boxing, his wife Odette persuaded him to embrace her, and I did the deed from the rear. He was not happy with me, it must have been very painful, but within a very short time he was on his knees, then lying down and soon snoring. Ben produced a straightjacket, the ambulance arrived and they took him off to Littlemore Mental Hospital.
Neurological Manifestations of Medical Disorders
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
In the final stage of withdrawal, delirium tremens, there are vivid hallucinations, often frightening (seeing animals or insects), marked confusion, anxiety and overactivity, leading to insomnia. DTs usually start 2–4 days after stopping drinking, and usually last 2–3 days, but occasionally may last much longer. Treatment of DTs includes adequate sedation, rehydration and usually parenteral feeding with glucose solutions and thiamine given intravenously. Any concomitant infection or injury should be treated appropriately. Sedatives used include benzodiazepines, such as lorazepam, chlordiazepoxide or diazepam. Paraldehyde is effective treatment to sedate and control seizures, but is now rarely used.
Gas chromatography-tandem mass spectrometric analysis of metaldehyde and its metabolite acetaldehyde in initial assessment of hemodialysis abatement of toxicity in live animals
Published in Toxicology Mechanisms and Methods, 2023
Andreas F. Lehner, Claudia Iannucci, Birgit Puschner, John P. Buchweitz
Eckert et al. (2012) have provided a detailed summary of physicochemical properties of the key monomer of metaldehyde, i.e. acetaldehyde. Leibig in 1835 initially characterized acetaldehyde as an oxidation product of alcohol, naming it ‘alcohol dehydrogenatus’, which contracted to aldehyde. Acetaldehyde is capable of generating polymeric forms under certain conditions, most notably the cyclic trimer paraldehyde useful in chemical syntheses, the rubber-like polymer polyacetaldehyde, and the titular cyclic tetramer metaldehyde. The latter is prepared in the presence of HBr and alkaline earth metal bromides at low temperatures, a process that also generates paraldehyde. It can depolymerize at 80 °C, particularly in the presence of acid catalysts. Despite low solubility in water, it has considerable toxicity to aquatic environments (Johnson et al. 2017; Balashova et al. 2021). Microbial capacity for metaldehyde degradation has been shown to exist in soil (Balashova et al. 2021) and various groups are investigating filtration methods for reduction of metaldehyde in aquatic environments which is also of great importance for drinking water supplies (Li et al. 2017, 2020; Rolph et al. 2019).
The advent of epilepsy directed neurosurgery: The early pioneers and who was first
Published in Journal of the History of the Neurosciences, 2023
Based on this, it was felt that the “focus of discharge was situated around the posterior end of the superior frontal sulcus” matching the site of scar (Figure 4a) and skull defect; this being measured as at the center of the upper third of the ascending convolution. Multiple daily seizures persisted, despite frequent treatment with paraldehyde and on May 25, he underwent surgery, which was documented in detail (Horsley 1886b, 29–34). The head was “scrubbed” with 1 in 20 carbolic and chloroform administered. The center of the quad radiate scar was “roughly estimated to lie just in front of the upper end of the fissure of Rolando.” Horsley, with trephines, created a bone flap (Figure 4b) and, after excising underlying dura, encountered the scar on the cortical surface (Figure 4c). By making a vertical incision around this, including a half-a-centimeter perimeter of adjacent brain, he was able to remove the scar, leaving only a deep seated residue felt to be connected with the “roof of the third ventricle.”
Craniocerebral nail gun injuries: a definitive review of the literature
Published in Brain Injury, 2021
The first case documented a 19-year-old male with a single intracranial nail injury who developed early seizures in the setting of meningitis (on day four post-injury). This was treated with paraldehyde, dilantin, and phenobarbitone (29). The second case involves a 28-year-old male with a single intracranial nail, who developed a tonic-clonic seizure lasting 5 min on day 5 post-injury. This early seizure was successfully treated with phenytoin (9). The final case pertains to a 17-year-old male with 24 intentional intracranial nails. He suffered a late partial seizure of his left arm (2 weeks after his injuries) and responded to an increased dosage of phenytoin (30).
Related Knowledge Centers
- Acetaldehyde
- Acetic Acid
- Ethanol
- Methyl Group
- Sulfuric Acid
- 1,3,5-Trioxane
- Hydrogen
- Metaldehyde
- Properties of Water
- Bromal