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Prehospital Administration of Rectal Diazepam in Pediatric Status Epilepticus

Published online by Cambridge University Press:  28 June 2012

Rodney E. Drawbaugh*
Department of Emergency Medicine, York Hospital, York, Pa., USA
Christopher G. Deibler
Department of Emergency Medicine, York Hospital, York, Pa., USA
David R. Eitel
Department of Emergency Medicine, York Hospital, York, Pa., USA
Rodney E. Drawbaugh, EMS Systems Coordinator, York Hospital, 1001 South George Street, York, PA 17405, USA (717) 771-2450


Seizures are a common pediatric problem encountered by prehospital personnel. Status epilepticus is defined as seizure activity lasting longer than 15 minutes, or recurrent seizures that occur close together without a period of consciousness between ictal periods. It is estimated that 60,000 to 160,000 cases of status epilepticus occur each year within the United States. Prior to 1960, status epilepticus carried a 50% morbidity rate. However, improved anticonvulsive medications, aggressive airway management, and the spread of EMS Systems throughout the nation have reduced the morbidity rate to a range of 8% to 12%.

Prompt and vigorous treatment is paramount in the successful management of status epilepticus because delays can result in neuronal damage and death. Although intravenous diazepam currently is the drug of choice to terminate seizure activity, it may be difficult to rapidly establish a patent intravenous (IV) line during status epilepticus in young children with vigorous motor activity. Alternate routes, such as intramuscular injections, are unreliable due to unpredictable absorption. Rectal administration of diazepam may provide an useful alternate route for delivery of the drug during status epilepticus when IV attempts fail.

In this review, the authors discuss a case of status epilepticus wherein intravenous access could not be established rapidly and the patient was given diazepam rectally with favorable results.

Case Report
Copyright © World Association for Disaster and Emergency Medicine 1990

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1. Browne, TR, Feldman, RG (eds): Epilepsy: Diagnosis and Management. Boston, Little, Brown, 1983, pp. 341354.Google Scholar
2. Delgado-Escueta, A, Westelain, C, Trieman, D, et al: Current concepts in Neurology: Management of status epilepticus. N Engl J Med 1982;306:13371340.Google Scholar
3. Hauser, A: Status Epilepticus: Frequency, etiology and neurological sequelae. Adv. Neurol 1983;34:314.Google Scholar
4. van der Kleyn, E, Baars, A, et al: Clinical pharmacokinetics of drugs used in the treatment of status epilepticus. Adv. Neurol 1983;34:314.Google Scholar
5. Chameides, L, et al (eds): Textbook of Pediatric Advanced Life Support. Dallas, American Heart Association, 1988, pp 4344.Google Scholar
6. Milligan, N, Dhillon, S, Richens, A, Oxley, J: Rectal diazepam in the treatment of absence status: A pharmacodynamic study. J Neurol Neurosurg Psychiatry 1981;10:914917.Google Scholar
7. Dulac, O, Aicardi, J, Rey, E, Olive, G: Blood levels of diazepam after single rectal administration in infants and children. J Pediatrics 1978;93:10391041.Google Scholar
8. Dhillon, S, Ngware, E, Richens, A: Rectal absorption of diazepam in epileptic children. Arch Dis Child 1982;57:264267.Google Scholar
9. Agurell, S, Berlin, A, Ferngren, H, et al: Plasma levels of diazepam after parenteral and rectal administration in children. Epilepsia 1975;16:277283.Google Scholar
10. Albano, R, Reisdorff, E, Wiegenstein, J: Rectal diazepam in pediatric status epilepticus. Am J Emerg Med 1989;70:168172.Google Scholar
11. Sonander, H, Arnold, E, Nilsson, K: Effects of the rectal administration of diazepam. Br J Anesthesia 1985;57:578580.Google Scholar
12. Knudsen, F: Rectal administration of diazepam in solution in the acute treatment of convulsions in infants and children. Arch Dis Child 1979;11:855857.Google Scholar
13. Hoppu, K, Santavuori, P: Diazepam rectal solution for home treatment of acute seizures in children. Ada Paediatr Scand 1981;70:369372.Google Scholar