Injecting diazepam rectally when treating convulsions in children

The article was professionally consulted with Master, Doctor Truong Thanh Tam - Pediatrician at the Department of Pediatrics - Neonatology - Vinmec Danang International General Hospital.

A child having a seizure is an emergency sign that needs to be treated quickly and promptly to avoid the risk of death. An rectal diazepam pump is a method of treating seizures in children in the emergency. In addition, diazepam is also used at home with the guidance and prescription of a doctor.

Children with impaired consciousness, epilepsy or convulsions are one of the emergency signs that need to be treated quickly. In the treatment of seizures in children, diazepam is the first-line treatment, used in emergency situations. The drug is used as an rectal pump for infants and young children when intravenous injection is not possible.
Diazepam can be used intravenously for anal injection or as an anal pump because of similar efficacy and safety assurance.

Anal diazepam pump is indicated when the child has a seizure, the seizure lasts for 5 - 10 minutes, the way to do it is as follows:
Use a 1ml syringe, remove the needle, withdraw 1 dose of diazepam from the syringe into the vial. Insert the syringe 4 - 5 cm deep into the anus and inject the diazepam. Hold the baby's bottom firmly for a few minutes. Dosage of diazepam rectal 10mg/2ml/tube is 0.1ml/kg, based on the child's weight, the specific dose is:
Children from 2 weeks to 2 months old, weighing < 4kg: 0.3 ml . Children from 2 to under 4 months old, weighing from 4 to under 6kg: 0.5 ml. Children from 4 to under 12 months old, weighing from 6 to under 10kg: 1.0 ml. Children from 1 to under 3 years old, weighing from 10 to under 14kg: 1.25 ml. Children from 3 to under 5 years old, weighing from 14-19 kg: 1.5 ml. For infants under 2 weeks of age, use phenobarbital 200mg/ml/vial with a dose of 20mg/kg depending on the baby's weight. If the body weight is 2kg, the starting dose is 0.2ml and after 30 minutes the repeat dose is 0.1ml. If the body weight is 3kg, the starting dose is 0.3ml and after 30 minutes the repeat dose is 0.15ml.

Monitor the child's convulsive status after rectal administration of diazepam:
If after 10 minutes the child still has convulsions: Use a second dose of diazepam or slow intravenous diazepam at a dose of 0.05ml/kg equivalent to 0.25mg/ kg (if intravenous access is available). Note, do not use more than 2 doses of diazepam. If after the next 10 minutes the child still has convulsions and a status epilepticus is suspected: Phenobarbital 15mg/kg intravenously or intramuscularly over 15 minutes or Phenytoin 15-18mg/kg intravenously over 60 minutes. Note, injection is different from diazepam). While taking diazepam rectally, if the child has a high fever, it is necessary to:
Take off and loosen the child's clothes, creating a ventilated space. Do not use any other oral medications until the child has stopped convulsions. When the seizure is over and the child is able to drink, give paracetamol or ibuprofen. In case the child stops breathing, breathing aids should be available.

Anal pump diazepam for children at home is indicated in the following cases:
The child has convulsions, seizures lasting more than 10 minutes. The child has responded to diazepam intravenously or rectally in the past. If the child has taken the medicine but the child does not respond to the medicine within 10 minutes, the child should be taken to the hospital immediately. Children tend to have cluster (cluster) seizures and are unresponsive to oral diazepam. The child has a history of idiopathic seizures and is responsive to diazepam. Before being taken to the hospital, the child may be given diazepam rectally. The child has a history of severe seizures and is far from medical facilities. However, it should be noted that repeated doses of diazepam should not be used in close proximity because of the potential for increased risk of respiratory depression, which can be life-threatening in the child. In addition, rectal diazepam is not used in children with epilepsy but is well controlled.

The drug has a long-lasting effect and prevents re-convulsions, giving family members more time to take the child to a medical facility. Lower likelihood of respiratory depression. Lower ability to affect blood pressure, causing lethargy. Diazepam rectally is used to treat seizures in infants and young children. The drug is also used at home with children with epilepsy, but family members need to be trained in its use and use as directed and directed by a doctor. It is best to call 911, then give the child medication while waiting for transportation to the hospital.
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