Antipsychotic toxicity: Difference between revisions
(Created page with "==Background== *Toxicity results in blockade of some or all of the following receptors: **Dopamine - extrapyramidal symptoms **Alpha1 - orthostatic hypotension, reflex tachycardi...") |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Isolated overdose of antipsychotics is rarely fatal | |||
*Toxicity results in blockade of some or all of the following receptors: | *Toxicity results in blockade of some or all of the following receptors: | ||
**Dopamine - extrapyramidal symptoms | **Dopamine - extrapyramidal symptoms | ||
** | **Alpha-1 - orthostatic hypotension, reflex tachycardia | ||
**Muscarinic - anticholinergic symptoms | **Muscarinic - anticholinergic symptoms | ||
**Histamine - sedation | **Histamine - sedation | ||
==Clinical Features== | ==Clinical Features== | ||
| Line 12: | Line 12: | ||
###Tongue protrusion, facial grimacing, trismus, oculogyric crisis | ###Tongue protrusion, facial grimacing, trismus, oculogyric crisis | ||
##Akathisia | ##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 | |||
==Treatment== | ==Treatment== | ||
#Supportive | |||
##Hypotension | |||
###IVF | |||
###Norepi | |||
##QT prolongation | |||
###Treat all pts w/ QTc >500ms w/ magnesium 2-4gm IV over 10min | |||
#Extrapyramidal | #Extrapyramidal | ||
##Diphenhydramine 25-50mg IV/IM OR benztropine 1-2mg IV/IM | ##Diphenhydramine 25-50mg IV/IM OR benztropine 1-2mg IV/IM | ||
##Oral therapy with either of above meds should be continued for 2 weeks | ##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== | ==See Also== | ||
Revision as of 21:34, 1 January 2012
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
Treatment
- Supportive
- Hypotension
- IVF
- Norepi
- QT prolongation
- Treat all pts w/ QTc >500ms w/ magnesium 2-4gm IV over 10min
- Hypotension
- 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