Lomotil toxicity: Difference between revisions
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==Background== | ==Background== | ||
*Mixture of diphenoxylate / atropine used to treat diarrhea | *Mixture of [[diphenoxylate/atropine]] used to treat diarrhea | ||
*Children are especially sensitive to toxicity (death reported after ingestion of <5 tablets) | *Children are especially sensitive to toxicity (death reported after ingestion of <5 tablets) | ||
==Mechanism of toxicity== | ===Mechanism of toxicity=== | ||
*Diphenoxylate | *[[Diphenoxylate]] | ||
** | **[[Opioid]] analog of [[meperidine]], which has opioid-like toxicity in overdose | ||
*Atropine | *[[Atropine]] | ||
** | **[[Anticholinergic effects]] | ||
*Toxic dose is variable | *Toxic dose is variable | ||
==Clinical Features== | ==Clinical Features== | ||
*Atropine effects | *Atropine effects | ||
**Lethargy, agitation, flushing, dry mucous membranes, mydriasis, ileus, tachycardia | **[[Lethargy]], [[agitation]], flushing, dry mucous membranes, mydriasis, [[ileus]], [[tachycardia]] | ||
*Opioid effects | *Opioid effects | ||
**Miosis, coma, respiratory depression, respiratory arrest | **Miosis, [[coma]], respiratory depression, [[respiratory arrest]] | ||
==Differential Diagnosis== | |||
{{Sedatve/hypnotic toxicity types}} | |||
{{Anticholinergic types}} | |||
==Evaluation== | ==Evaluation== | ||
| Line 20: | Line 25: | ||
==Management== | ==Management== | ||
*Maintain airway and support ventilation, if needed | *Maintain airway and support [[ventilation]], if needed | ||
*Naloxone 1-2mg IV for apnea, coma, or lethargy (may require repeat dosing) | *[[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== | ==Disposition== | ||
*Pediatric patients should be observed in the ICU for 24 hours given risk of sudden respiratory arrest | *Pediatric patients should be observed in the ICU for 24 hours given risk of sudden respiratory arrest | ||
==See Also== | |||
*[[Opioid toxicity]] | |||
*[[Diphenoxylate/atropine]] | |||
*[[Anticholinergic toxicity]] | |||
==References== | ==References== | ||
*Olson, K. Poisoning and Drug Overdose Clinical Manual. 2004 | *Olson, K. Poisoning and Drug Overdose Clinical Manual. 2004 | ||
[[Category:Toxicology]] | |||
Latest 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
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[1]
- 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.