Lomotil toxicity: Difference between revisions
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**[[Opioid]] analog of [[meperidine]], which has opioid-like toxicity in overdose | **[[Opioid]] analog of [[meperidine]], which has opioid-like toxicity in overdose | ||
*[[Atropine]] | *[[Atropine]] | ||
**[[ | **[[Anticholinergic effects]] | ||
*Toxic dose is variable | *Toxic dose is variable | ||
{{Anticholinergic types}} | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 22:02, 27 March 2024
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
- Toxic dose is variable
Anticholinergic toxicity Causes
- Medications[1]
- Atropine
- Antihistamines
- Antidepressants
- Antipsychotics
- Muscle relaxants
- Anti-Parkinsonians
- Plants
- Jimson weed (Devil's trumpet)
- Amanita mushroom
Clinical Features
- Atropine effects
- Lethargy, agitation, flushing, dry mucous membranes, mydriasis, ileus, tachycardia
- Opioid effects
- Miosis, coma, respiratory depression, respiratory arrest
Differential Diagnosis
Sedative/hypnotic toxicity
- Absinthe
- Barbiturates
- Benzodiazepines
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Opioids
- Toxic alcohols
- Xylazine toxicity
Anticholinergic toxicity Causes
- Medications[2]
- Atropine
- Antihistamines
- Antidepressants
- Antipsychotics
- Muscle relaxants
- Anti-Parkinsonians
- Plants
- Jimson weed (Devil's trumpet)
- Amanita mushroom
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)
- Activated charcoal should be given promptly if available
- No evidence for utility of physostigmine
Disposition
- Pediatric patients should be observed in the ICU for 24 hours given risk of sudden respiratory arrest
See Also
References
- Olson, K. Poisoning and Drug Overdose Clinical Manual. 2004
- ↑ Dawson AH, Buckley NA. Pharmacological management of anticholinergic delirium – theory, evidence and practice. Br J Clin Pharmacol. 2015;81(3):516-24.
- ↑ Dawson AH, Buckley NA. Pharmacological management of anticholinergic delirium – theory, evidence and practice. Br J Clin Pharmacol. 2015;81(3):516-24.