Acute dystonic reaction as medical emergency: A report of two cases

Oyewole, AO; Adelufosi, AO; Abayomi, O Adelaja

doi:10.4103/2141-9248.117932

Cited by 23 publications

(32 citation statements)

References 14 publications

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“…The incidence of these reactions is underestimated due to lack of data collection and under-reporting of cases. Female patients, children, adults less than 30 years of age, and patients receiving high doses of metoclopramide have higher chances of developing dystonic reactions [1, 5, 7, 9]. Our patient was a 16-year-old female, so compared to the general population, she had a slightly increased risk of having a dystonic reaction to metoclopramide.…”

Section: Discussionmentioning

confidence: 82%

“…It also highlights the shortcomings of hospitals in resource-limited settings for managing this adverse reaction. This is a critical issue because the manifestations of an acute dystonic reaction following the administration of an anti-emetic may be life-threatening in rare instances [1, 13, 14]. Hence, health policies should dictate that institutions which administer metoclopramide and other dystonia-inducing drugs should be well equipped to handle their extrapyramidal adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“…Dystonia is a movement disorder characterized by involuntary, sustained or spasmodic contractions of muscle groups, resulting in twisting, repetitive and abnormal positions [1]. Acute dystonic reactions are the most common type of extrapyramidal reactions associated with the use of metoclopramide [2].…”

Section: Introductionmentioning

confidence: 99%

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Metoclopramide induced acute dystonic reaction: a case report

Tianyi

Agbor²,

Njim

2017

BMC Res Notes

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BackgroundMetoclopramide is a commonly used anti-emetic drug known to cause extrapyramidal symptoms as adverse effects, amongst which are dystonic reactions. These reactions are more frequent at high doses of metoclopramide, in female patients, children and adults less than 30 years of age. We hereby present the case of a 16 year old female who had dystonic reactions from metoclopramide, highlighting its unpredictable nature and the shortcomings of the management in resource-limited settings.Case presentationA 16 year old female Muslim from the Extreme North of Cameroon with no significant past history, was treated for severe malaria and associated refractory vomiting using intravenous quinine and metoclopramide respectively. She developed dystonic reactions after being administered her second dose of metoclopramide. The drug was discontinued and she was administered 8 mg of chlorpheniramine by mouth. Her symptoms resolved after 4 h. She was discharged 2 days later with no further complaints.ConclusionsMetoclopramide causes dystonic reactions which are often unpredictable and is frequently prescribed by health providers. This creates an environment of anxiety for the patient and the caregiver, and can result in life threatening consequences. Patients on metoclopramide should be monitored closely to detect these reactions early, and health facilities should be equipped to cope with the adverse effects before administration.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Metoclopramide induced acute dystonic reaction: a case report

Tianyi

Agbor²,

Njim

2017

BMC Res Notes

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“…Patients presented with acute dystonic reaction are frequently seen either in the emergency department (ED) or in the psychiatric wards. In the ED setting, this condition is often misdiagnosed, causing a delay in intervention,3 increasing morbidity and risk of mortality.…”

Section: Discussionmentioning

confidence: 99%

Persistent oromandibular dystonia and angioedema secondary to haloperidol

Masiran

2017

BMJ Case Reports

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We report a case in a young man who developed acute, persistent and painful tongue protrusion followed by swelling for more than 24 hours. He had relapse symptoms of schizophrenia and had recently received a single dose of parenteral haloperidol to manage his agitation. His record showed history of similar event and he has been taking atypical antipsychotic for maintenance. Mental state examination on admission revealed an agitated man with disorganised speech, restricted affect, auditory hallucination and persecutory delusion. His dystonia and oedema improved after 3 days. His mental status also recovered with the maintenance of low-potency antipsychotic and anticholinergic antiparkinsonian medications.

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“…It also causes extrapyramidal manifestations such as neuroleptic malignant syndrome, tardive dyskinesia, drug-induced parkinsonism, akathisia and acute dystonic reaction (8). Manifestation of acute dystonic reaction include upper airway obstruction from pharyngeal muscle spasms or laryngospasm, oculogyric crisis, torticollis, trismus, dysarthria, dysphonia, opistotonus, oropharyngeal dysphagia, temperomandibular joint dislocation, slurred speech, tongue protrusion and neck-stiffness (9)(10)(11)(12). Male gender, children, young adults, and high dose are established risk factors for metoclopramide-induced acute dystonic reaction (13,14).…”

Section: Introductionmentioning

confidence: 99%

Metoclopramide-induced Acute Dystonic Reaction: A Case Report

Akhigbe¹,

Adelekan²

2016

West Indian Med J

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Background: Acute dystonic reaction (ADR) is a fatal emergency condition. Drugs that have been implicated to induce ADR include metoclopramide. Aim: This study documents an interesting case of a young woman who had metoclopramideinduced acute dystonic reaction, ADR. Methods: This study reports a case of a patient who was managed for enteric fever and subsequently developed ADR following exposure to intravenous metoclopramide. Results: A 24-year-old female being managed as a case of enteric fever and placed on intravenous antibiotics and metoclopramide following persistent vomiting. She developed ADR after 24 hours of metoclopramide administration. 10 mg intravenous diazepam was given as a bolus, and the offending drug was discontinued. A second bolus was repeated after 10 minutes when ADR manifestations failed to resolve. Manifestation subsequently resolved with no recurrence. Conclusion: It is important to monitor patients on metoclopramide for features of ADR. This will help in the rapid diagnosis and prompt management of ADR. Diazepam, 10 mg, given as bolus intravenously has been shown to be useful in the management of this emergency condition. A second bolus can be given after 10 minutes if patient does not respond. Two doses of 10 mg of intravenous diazepam given 10 minutes apart was shown to be effective.

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Acute dystonic reaction as medical emergency: A report of two cases

Cited by 23 publications

References 14 publications

Metoclopramide induced acute dystonic reaction: a case report

Metoclopramide induced acute dystonic reaction: a case report

Persistent oromandibular dystonia and angioedema secondary to haloperidol

Metoclopramide-induced Acute Dystonic Reaction: A Case Report

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