Now-a-days mostly plastic syringes are
available for use. In an emergency situation, is it safe to use a
plastic syringe for administering paraldehyde injection in a child
with status epilepticus?
10-3-85/9, East Maredpally,
Secunderabad-26, A.P., India.
Paraldehyde has been in clinical use since 1882
for the treatment of status epilepticus in children as well as
adults. It, however, is unstable, making storage and
administration difficult; it also interacts with some plastics,
which further complicates administration.
Reports of incompatibility of paraldehyde with
disposable plastic syringes have been published as early as 1959
where the authors noted that paraldehyde dissolved a plastic
syringe made of polystyrene within a relatively short period of
time(1). An experiment involving the exposure of plastic
disposable syringes to paraldehyde for a five-minute period showed
increased resistance to injection, hairline fractures of the shaft
and plunger in two minutes, and breaks in the shaft(2). Some
brands of plastic syringes, however, have been reported to be
stable in the presence of paraldehyde for upto 3 hours(3).
Plastic syringes are made of polypropylene. The
commonly used plasticizer in these syringes is di (2-ethylhexyl)
phthalate (DHEP) which can be leached by paraldehyde. DHEP has
potential toxicity for the heart, lungs, liver and reproduc-tive
organs in experimental animals. No specific defined lesions in
humans have been associated with its use though risk remains. A
necrotizing dermatitis and a plasticizer-induced hepatitis like
syndrome have been described following extensive use of blood
tubing. Polyneruopathies have been also described in one series of
The rubber portion of the plunger causes
leaching of 2-(2 hydroxyethylthio) benzothia-zide (HEB). It is
used as a possible accelerator in the vulcanization of rubber. It
may cause dermatological reactions in man and can displace
bilirubin from albumin and hence increase the risk of kernicterus.
In mice, HEB is neuro and hepatotoxic(4).
Thus considering the physical effects of
paraldehyde on plastic syringes, paraldehyde should be
administered by a glass syringe. In an emergency situation,
however, the drug may be administered immediately by a plastic
Department of Pediatrics,
All India Institute of Medical Sciences,
New Delhi 110 029, India.
1. Autian J, Dhorda CN. Evaluation of
disposable plastic syringes as to physical incompatibilties with
parenteral products. Am J Hosp Pharm 1959; 16: 176-179.
2. Addy DP, Alesbury P, Winter L. Paraldehyde
and plastic syringes. Br Med J 1978; 2: 1434.
3. Lockman LA. Paraldehyde. In:
Antiepileptic Drugs. Eds. Levy RH, Mattson RH, Meldrum BS. New
York, Raven Press, 1995; pp 963-967.
4. Ellenhorn MJ, Schonwald S, Ordog G, Wasserberger J.
Ellenhorn’s Medical Toxico-logy: Diagnosis and Treatment of
Human Poisoning, 2nd edn. Baltimore, Williams and Wilkins, 1997;