Diferencia entre revisiones de «Antipsychotic toxicity»
| Línea 20: | Línea 20: | ||
##Sinus tachycardia | ##Sinus tachycardia | ||
##QT prolongation | ##QT prolongation | ||
==Differential Diagnosis== | |||
{{Anticholinergic types}} | |||
==Treatment== | ==Treatment== | ||
#Supportive | #Supportive | ||
##Hypotension | ##[[Hypotension]] | ||
###IVF | ###[[IVF]] | ||
### | ###[[Norepinephrine]] | ||
##QT prolongation | ##[[QT prolongation]] | ||
###Treat all pts w/ QTc >500ms w/ magnesium 2-4gm IV over 10min | ###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 | ||
Revisión del 03:27 16 dic 2014
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.