Lomotil toxicity: Difference between revisions
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*Children are especially sensitive to toxicity (death reported after ingestion of <5 tablets) | *Children are especially sensitive to toxicity (death reported after ingestion of <5 tablets) | ||
==Mechanism of toxicity== | ===Mechanism of toxicity=== | ||
*Diphenoxylate | *Diphenoxylate | ||
**opioid analog of meperidine, which has opioid-like toxicity in overdose | **opioid analog of meperidine, which has opioid-like toxicity in overdose | ||
*Atropine | *[[Atropine]] | ||
**anticholinergic effects | **anticholinergic effects | ||
*Toxic dose is variable | *Toxic dose is variable | ||
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*Opioid effects | *Opioid effects | ||
**Miosis, coma, respiratory depression, respiratory arrest | **Miosis, coma, respiratory depression, respiratory arrest | ||
==Differential Diagnosis== | |||
==Evaluation== | ==Evaluation== | ||
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==Disposition== | ==Disposition== | ||
*Pediatric patients should be observed in the ICU for 24 hours given risk of sudden respiratory arrest | *Pediatric patients should be observed in the ICU for 24 hours given risk of sudden respiratory arrest | ||
==See Also== | |||
==References== | ==References== | ||
Revision as of 21:44, 13 December 2016
Background
- Mixture of diphenoxylate / atropine used to treat diarrhea
- Children are especially sensitive to toxicity (death reported after ingestion of <5 tablets)
Mechanism of toxicity
- Diphenoxylate
- opioid analog of meperidine, which has opioid-like toxicity in overdose
- Atropine
- anticholinergic effects
- Toxic dose is variable
Clinical Features
- Atropine effects
- Lethargy, agitation, flushing, dry mucous membranes, mydriasis, ileus, tachycardia
- Opioid effects
- Miosis, coma, respiratory depression, respiratory arrest
Differential Diagnosis
Evaluation
- Diagnosis is based on history and signs of toxicity
Management
- Maintain airway and support ventilation, if needed
- Naloxone 1-2mg IV for apnea, coma, or lethargy (may require repeat dosing)
- No evidence for utility of physostigmine
- Activated charcoal should be given promptly if available
Disposition
- Pediatric patients should be observed in the ICU for 24 hours given risk of sudden respiratory arrest
See Also
References
- Olson, K. Poisoning and Drug Overdose Clinical Manual. 2004