Antipsychotic toxicity: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Extrapyramidal | |||
**Acute dystonia | |||
***Tongue protrusion, facial grimacing, trismus, oculogyric crisis | |||
**Akathisia | |||
*CNS | |||
**Lethargy, ataxia, dyarthria, confusion, coma | |||
**Seizure (1%) | |||
*Anticholinergic Effects | |||
**Tachycardia, dry mucous membranes, dry skin, decreased bowel sounds, delirium | |||
*ECG changes | |||
**Sinus tachycardia | |||
**QT prolongation | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 25: | Line 25: | ||
==Treatment== | ==Treatment== | ||
*Supportive | |||
**[[Hypotension]] | |||
***[[IVF]] | |||
***[[Norepinephrine]] | |||
**[[QT prolongation]] | |||
***Treat all pts w/ QTc >500ms w/ magnesium 2-4gm IV over 10min | |||
*Extrapyramidal | |||
**[[Diphenhydramine]] 25-50mg IV/IM OR [[benztropine]] 1-2mg IV/IM | |||
**Oral therapy with either of above meds should be continued for 2 weeks | |||
==Disposition== | ==Disposition== | ||
Revision as of 12:21, 18 July 2015
Background
- Isolated overdose of antipsychotics is rarely fatal
- Toxicity results in blockade of some or all of the following receptors:
- Dopamine - extrapyramidal symptoms
- Alpha-1 - orthostatic hypotension, reflex tachycardia
- Muscarinic - anticholinergic symptoms
- Histamine - sedation
Clinical Features
- Extrapyramidal
- Acute dystonia
- Tongue protrusion, facial grimacing, trismus, oculogyric crisis
- Akathisia
- Acute dystonia
- CNS
- Lethargy, ataxia, dyarthria, confusion, coma
- Seizure (1%)
- Anticholinergic Effects
- Tachycardia, dry mucous membranes, dry skin, decreased bowel sounds, delirium
- ECG changes
- Sinus tachycardia
- QT prolongation
Differential Diagnosis
Anticholinergic toxicity Causes
- Medications[1]
- Atropine
- Antihistamines
- Antidepressants
- Antipsychotics
- Muscle relaxants
- Anti-Parkinsonians
- Plants
- Jimson weed (Devil's trumpet)
- Amanita mushroom
Treatment
- Supportive
- Hypotension
- QT prolongation
- Treat all pts w/ QTc >500ms w/ magnesium 2-4gm IV over 10min
- Extrapyramidal
- Diphenhydramine 25-50mg IV/IM OR benztropine 1-2mg IV/IM
- Oral therapy with either of above meds should be continued for 2 weeks
Disposition
- Consider discharge after 6hr as long as there are all of the following:
- No mental status changes
- Normal HR/BP
- No orthostatic hypotension
- Normal QT interval
See Also
Source
- Tintinalli
- ↑ Dawson AH, Buckley NA. Pharmacological management of anticholinergic delirium – theory, evidence and practice. Br J Clin Pharmacol. 2015;81(3):516-24.