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Paraldehyde
General information
Paraldehyde is the cyclic trimer of acetaldehyde, a colorless or slightly yellow-colored liquid. It has been used as an anticonvulsant, but because of adverse reactions and because it is difficult to use it has been replaced by more modern agents. However, it is still sometimes used to treat status epilepticus that is resistant to first-line drugs [ ]. The usual adult rectal dose is 10–20 ml.
Paraldehyde is a solvent for rubber, polystyrene, and styrene acrylonitrile co-polymer, and if parenteral administration is required it should ideally be given via a glass syringe [ ]. Plastic syringes start to break down after exposure of about 2 minutes [ ]. However, some plastic syringes are resistant to its effects for a few hours [ ], and intravenous tubing is reportedly unaffected [ ]; in an emergency it has been given rapidly by plastic syringe.
Drug studies
Observational studies
In a prospective audit of the use of rectal paraldehyde in the management of 53 episodes of acute tonic-clonic convulsions in 30 children aged 5 months to 16 years, the mean dose of paraldehyde was 0.65 ml/kg [ ]. Rectal paraldehyde terminated the convulsion in 33 episodes. There were no episodes of respiratory depression.
Organs and systems
Cardiovascular
Paraldehyde caused microembolization in a neonate immediately after the injection of 0.3 ml/kg [ ]. The skin below the waist became red, large purple vesicles formed, and there was loss of skin and sloughing of two toes.
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