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It is quite clear from the side effect profiles of the 2 medications
that diazepam has a higher rate of significant respiratory depression in
the pediatric age group as compared to lorazepam, in their usual dose
range. We do NOT use diazepam any more for status epilepticus in the ED.
Also the duration of action of lorazepam is much longer than diazepam,
which is another favorable profile.[ 6-8 hours versus "less than an
hour"]
 
In the field, if you do not have IV access you can use the injectable
preparation  of diazepam by the rectal route (0.5 mg/kg) with a
tuberculin syringe as an option. The rectal pharmacokinetics of diazepam
are more predictable and favorable from the evidence in the literature,
than those of lorazepam.
 
Actually, we now have a new preparation of rectal diazepam. "Diastat" by
Athena pharmaceuticals which is a convenient rectal gel available in
unit dose vials of  2.5 mg, 5 mg, 10 mg. It is very expensive. ...??$200
per box which has has 2 doses.
 
Yes, IM midazolam which you asked about is also an option in the field.
Jim Chamberlein published his study comparing IM Midazolam (0.2 mg/kg)
with IV diazepam(0.3 mg/kg) with comparable results. [PEC 1997;13:92-94]
The IM route resulted in a slightly quicker cessation of seizures
because of faster administration.
 
hope that helps
 
        [Jay Pershad, M.D.]
> -----Original Message-----
> From: Paul S. Robinson [SMTP:[log in to unmask]]
> Sent: Wednesday, April 08, 1998 3:50 PM
> To:   Multiple recipients of list PED-EM-L
> Subject:      Versed (Instead?)
>
> A question from my "other boss" is being cross-posted for discussion.
> The
> concern here is the pre-hospital arena.
>
>
> >What do you guys think about the use of
> >lorazepam for the treatment of pediatirc siezures?  Lacey et al (J
> >Pediatrics 19086;108:771) apparently have reported a 27% for those
> >given lorazepam but a whopping 73% intubation rate for those
> >recieving diazepam.  These rates seem awfully high but there still
> >seems to be a difference between these 2 drugs or perhaps the way
> >they're used.
>
> >I sit on the prehospital medical advisory committee for the XX
> >Epilepsy Foundation and talking to those pedipods, I get the distinct
> >impression that many of these kids arrest in the ED or, even more so,
> >in the PICU after EMS has left.  The problem is so bad according to
> >them that we produced a button that said simply "Bring em in
> >Pink".
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html