ABSTRACT
In childhood, several drugs are the cause of acute extrapyramidal syndromes which are true medical emergencies. In the course of one year out of 321 children with acute poisoning, 49 (14.9%) showed these side effects. The responsible drugs were mainly the phenothiazines and haloperidol; only in two cases the metoclopramide. The extrapyramidal syndromes were characterized by akathisia, dyskinesia with dystonic reactions, parkinsonism and akinesia. Diphenhydramine has shown to be useful in treating acute extrapyramidal disturbances when used intravenously followed by oral administration.
Subject(s)
Antipsychotic Agents/adverse effects , Basal Ganglia Diseases/chemically induced , Haloperidol/adverse effects , Metoclopramide/adverse effects , Acute Disease , Adolescent , Basal Ganglia Diseases/drug therapy , Child , Child, Preschool , Diphenhydramine/pharmacology , Diphenhydramine/therapeutic use , Extrapyramidal Tracts/drug effects , Female , Humans , Iatrogenic Disease , Infant , Male , Phenothiazines , Receptors, Dopamine/drug effectsABSTRACT
En la edad pediatrica, diversas drogas pueden causar sintomas extrapiramidales que por su evolucion aguda constituyen verdaderas urgencias medicas. En el transcurso de un ano, del total de 321 ninos internados con el diagnostico de intoxicacion aguda, 48 (14.9%) habian recibido ese tipo de drogas. De estas, las que con mayor frecuencia causaron los sintomas fueron las fenotiacinas y el haloperidol; la manera como los ninos se expusieron a ellas fue en la mayor parte de los casos por yatrogenia y despues por ingestion accidental. Las manifestaciones clinicas que predominaron fueron acatisia, discinesias paroxisticas del tipo de las crisis oculogiras, las distonias de torsion de cuello y tronco y las crisis bucolinguales, parkinsonismo caracterizado por temblores finos, sialorrea e hipertonia y finalmente, acinesia. Se propone un esquema de tratamiento empleando unicamente difenhidramina por via parenteral y bucal con lo que se obtienen buenos resultados terapeuticos
Subject(s)
Basal Ganglia Diseases , Haloperidol , Metoclopramide , PhenothiazinesABSTRACT
The authors reviewed the clinical histories of 50 children admitted to the Emergency Department of Hospital de Pediatría, C.M.N., I.M.S.S. from 1971 through 1975, with the diagnosis of lomotil intoxication. No differences were found as to sex. Frequency was greater at ages from 2 to 3 years from accidental mechanism, which increased between 1973 to 1975. Lethality was similar to that reported by other authors. In the clinical picture, the depressive action of diphenoxylate and the anticholinergic action of atropine were outstanding, without being possible to establish the limits between the two, with somnolence and flushness as main symptoms. The treatment given followed the purpose to eliminate the toxic: emesis, gastric washing and in cases of respiratory depression, naloxone was given. Therefore, it is concluded that since the value of lomotil in the treatment of diarrhea has not been proved and that the risk of its administration is greater than the benefit, this product should be proscribed, specially for pediatric use.
