Lomotil toxicity: Difference between revisions
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Revision as of 21:43, 13 December 2016
Background
- Mixture of diphenoxylate / atropine used to treat diarrhea
- Children are especially sensitive to toxicity (death reported after ingestion of <5 tablets)
Mechanism of toxicity
- Diphenoxylate
- opioid analog of meperidine, which has opioid-like toxicity in overdose
- Atropine
- anticholinergic effects
- Toxic dose is variable
Clinical Features
- Atropine effects
- Lethargy, agitation, flushing, dry mucous membranes, mydriasis, ileus, tachycardia
- Opioid effects
- Miosis, coma, respiratory depression, respiratory arrest
Evaluation
- Diagnosis is based on history and signs of toxicity
Management
- Maintain airway and support ventilation, if needed
- Naloxone 1-2mg IV for apnea, coma, or lethargy (may require repeat dosing)
- No evidence for utility of physostigmine
- Activated charcoal should be given promptly if available
Disposition
- Pediatric patients should be observed in the ICU for 24 hours given risk of sudden respiratory arrest
References
- Olson, K. Poisoning and Drug Overdose Clinical Manual. 2004