Paraldehyde = 2,4,6-trimethyl-1,3,5-trioxane (trioxane = 6 member ring of 3 carbon atoms alternating with 3 oxygen atoms)
Administration:
(1) It is irritating to the upper GI tract when taken orally.
(2) It is less irritating when administered as a rectal enema but can cause a proctitis.
(3) It can cause thrombophlebitis when injected intravenously unless diluted.
(4) Injections can result in pain, necrosis and sterile abscesses.
Normally it acts as a sedative and hypnotic. After prolonged use tolerance or addiction may develop, especially in chronic alcoholics.
Clinical findings in overdose:
(1) dizziness and syncope
(2) hypotension
(3) muscle relaxation
(4) right heart failure
(5) pulmonary edema
(6) miosis with no or little reaction to light
(7) skin rash
(8) gastritis or esophagitis if taken orally, with nausea and vomiting
(9) tachypnea or hypoventilation
(10) tachycardia or bradycardia
(11) renal failure
(12) respiratory failure
(13) CNS depression which may progress to coma
(14) severe metabolic acidosis, with hyperchloremia and a high anion gap
(15) abnormal aromatic smell to breath and urine
(16) marked leukocytosis
Complications are more serious if there is:
(1) concurrent liver disease
(2) concurrent heart or lung disease
(3) ingestion together with alcohol or other sedatives
(4) concomitant exposure to disulfiram
(5) concurrent inflammatory or ulcerative GI disease
Serum paraldehyde levels can be measured by gas chromatography.
