Nursing procedure – rectal administration of diazepam


• Gave 2 pushes of normal saline and started the child on antibiotics.


• The patient died 3 days after admission


James Lace, MD Childhood Health Associates of Salem; Mt. Meru Hospital, Tanzania; Kausay Wasi Clinic, Peru


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Status epilepticus
• Critically ill infant
• Rectal administration of diazepam

Differential Diagnosis

• Seizure (status epilepticus)
• Accidental poisoning
• Hypoglycemia
• Hypovolemic shock

Patient Workup History

• Mom was not forthcoming that she given the child herbal remedies.
• Patient had had some vomiting and diarrhea.
• Family had seen a local healer, who gave the patient two different types of herbs.
• Patient had severe complications before we found out about herbs/poisoning.

Physical Exam

• Pinpoint / non-reactive pupils
• Cap refill >6 seconds
• Blood sugar 0 on glucometer
• Seizures; stopped with rectal diazepam

Editor’s Notes

For this case- just a clinical pearl- the syringe is attached to a 23 gauge butterfly with the needle cut off. Inject the medication very slowly, the rectum is very vascular and the medication will be absorbed quickly. Also, when stimulating a child’s rectum – often it results in a BM. So, leave the catheter in for a few seconds before withdrawing it – that will allow all of the medication to be absorbed even if the child has a bowel movement when you withdraw the catheter, you will not loose all of the medication

– Michele Wolf, BSN, MSN, ARNP-BC, interim MSN Program Director at the University of Tampa in Florida.

Suggested References

Status epilepticus


• Gender: Female
• Age: 9 months
• Height: Not Available
• Weight: Not Available


• Temperature: 38 C
• Blood Pressure: Not Available
• Heart Rate: Not Available
• Respiratory Rate: Not Available
• Pulse Oximetry: 95% RA

Signs and Symptoms

Low blood sugar; seizures; non-reactive pupils; vomiting; diarrhea

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