Prolonged coma after tetanus.

Kendall, M. J.; Clarke, S W

doi:10.1136/bmj.1.5796.354

Cited by 16 publications

(4 citation statements)

References 5 publications

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“…at the synaptic membranes. The high affinity of the drug to lipoid tissues (Van der Kleijn, 1969) seems to conform with the Kendall and Clarke case of delayed regaining of consciousness in an obese patient treated with large doses of diazepam for tetanus; this was accounted for by the cumulative body stores (Kendall and Clarke, 1972).…”

Section: Discussionmentioning

confidence: 62%

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Transient psychological syndrome following diazepam therapy for tetanus

Malatinský¹,

Procházka²,

Kadlic³

1975

Postgraduate Medical Journal

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SummaryTwo cases of transitory reversible pathopsychological changes associated with diazepam therapy in tetanus are described. The psychopathology developed owing to an abrupt discontinuance of diazepam or to a sudden reduction of its dosage. The reinstitution of diazepam in low doses and the administration of regulators of cerebral metabolism resulted in a progressive normalization of the psychological state.It is suggested that the described syndrome was caused by two aetiological factors; the toxinfectious factor giving rise to the primary cerebral dysfunction, and the prolonged action of high doses of diazepam with a sudden withdrawal, playing a role as precipitating factor. EEG findings showed widespread abnormality which corresponded with the clinical diagnosis. Even the normalization in EEG correlated well with the disappearance of psychiatric symptomatology.To avoid such undesirable psychic side effects, a gradual discontinuance of the drug is recommended.

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Section: Discussionmentioning

confidence: 62%

“…Although occasional unexpected reactions to diazepam have been reported including a sudden cardiorespiratory depression (Rollason, 1968), prolonged unconsciousness (Kendall and Clarke, 1972) and even death resulting from withdrawal of diazepam (Relkin, 1966), the benefits of the drug outweigh the potential hazards.…”

Section: Introductionmentioning

confidence: 99%

Transient psychological syndrome following diazepam therapy for tetanus

Malatinský¹,

Procházka²,

Kadlic³

1975

Postgraduate Medical Journal

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“…En la mayoría el coma fue un evento previo a la muerte, sólo 2 pacientes se recuperaron, uno de los cuáles fue el caso atribuido al diazepán mencionado anteriormente. El tétanos generalmente respeta el nivel de la conciencia y el diazepán, a pesar de las dosis altas, usualmente tampoco la altera (1,18,46) excepto en ancianos, en quienes se ha descrito un estado de coma prolongado con una duración hasta de 12 días después de suspendido el medicamento y con una recuperación completa (15,42,47).…”

Section: Discussionunclassified

Tétanos en el Hospital Nacional Cayetano Heredia 1971-1990. Evolución y tratamiento

Légua¹,

Gotuzzo²,

Guerra³

et al. 2013

Rev Med Hered

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Se revisó las historias clínicas de 76 pacientes con tétanos del adulto (> 14 años de edad). Al final, 28 casos (36,8%) fueron leves. 12 (15,85) moderados, 24 (31,6) severos y 12(15,8%) muy severos. Las complicaciones más frecuentes fueron neumonía e infección del tracto urinario en 27 casos (35,55) cada una y retención urinaria en 24 (31,6%). El promedio de las dosis máximas de diazepán/día empleadas en los casos severos/muy severos (S/MS) (563 mg/día) estuvo muy por debajo de la recomendada en este hospital (20 mg/kg/día). La letalidad fue de 34,2% (26/76). La letalidad para los casos leves fue 3,6% (1/28), para los moderados 8,3% (10/12), para los muy severos. La letalidad para el grupo S/MS fue 66,7% (24/36). Las causas probables de muerte más frecuentes fueron: infección sobreagregada en 9 (34,659, hiperactividad simpática en 7 (26,9%9 y espasmo no controlado en 5 (23,7%). El número de casos no permitió detectar una diferencia significativa en la letalidad entre los pacientes severos tratados con antitoxina intratecal (25,0%) vs antitoxina sistémica (60,0%); entre los atendidos en la unidad de cuidados intensivos (28,6%) vs otros servicios (64,75); ni entre aquéllos tratados con ventilación mecánica (35,5%) vs sin ella (62,5%).

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“…Thus, the use of benzodiazepines for sedation, amnesia, and muscle relaxation is often considered a standard of care in the management of tetanus (5,7,8,33). However, the doses required to achieve adequate control of muscle rigidity and spasms can result in respiratory depression and coma, requiring mechanical ventilation (41,42). In addition, parenteral diazepam and lorazepam contain propylene glycol, which may increase the risk of lactic acidosis (8,43).…”

Section: Discussionmentioning

confidence: 99%

Magnesium sulfate for control of muscle rigidity and spasms and avoidance of mechanical ventilation in pediatric tetanus

Ceneviva

Thomas

Kees-Folts³

2003

Pediatric Critical Care Medicine

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An infusion of magnesium sulfate can be utilized to treat muscle spasms and severe generalized rigidity without the need for deep sedation, mechanical ventilation, or neuromuscular blockade. We recommend that magnesium sulfate be considered in the armamentarium of therapeutics utilized to treat muscle spasms and rigidity associated with tetanus, provided the patient's neurologic, cardiovascular, and respiratory status can be closely monitored in the pediatric intensive care unit.

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Prolonged coma after tetanus.

Cited by 16 publications

References 5 publications

Transient psychological syndrome following diazepam therapy for tetanus

Transient psychological syndrome following diazepam therapy for tetanus

Tétanos en el Hospital Nacional Cayetano Heredia 1971-1990. Evolución y tratamiento

Magnesium sulfate for control of muscle rigidity and spasms and avoidance of mechanical ventilation in pediatric tetanus

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