Tyramine reaction: Difference between revisions
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*Occurs when patient taking a monoamine oxidase inhibitor (MAO-I) ingests tyramine | *Occurs when patient taking a monoamine oxidase inhibitor (MAO-I) ingests tyramine | ||
**Tyramine is a dietary amine similar to amphetamine normally metabolized by MAO | **Tyramine is a dietary amine similar to amphetamine normally metabolized by MAO | ||
** | **Tyramine is a monoamine and acts indirectly to release catecholamines. | ||
**Tyramine is typically metabolized by monoamine oxidase in the gut, a process that MAOIs interfere with. | |||
**Tyramine is found in preserved meat, fish, cheese, alcohol, and protein-rich foods which are particularly likely to contain bacteria that convert amino acids into monoamines like tyramine. | |||
==Clinical Features== | ==Clinical Features== | ||
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**Severe occipital or temporal headache | **Severe occipital or temporal headache | ||
**Sympathomimetic effects: hypertension, diaphoresis, mydriasis, palpitations, chest pain | **Sympathomimetic effects: hypertension, diaphoresis, mydriasis, palpitations, chest pain | ||
*Syndrome usually resolves on own over 6 hours | |||
==Differential Diagnosis== | |||
{{Hypertension DDX}} | |||
==Evaluation== | |||
*[[ECG]]: monitor for cardiac ischemia | |||
*CT head: if patient has focal neurologic findings or persistent, severe headache | |||
==Management== | ==Management== | ||
* | *[[Hypertensive emergency]]: phentolamine is agent of choice | ||
**2.5-5mg IV q5-15min until blood pressure controlled | **2.5-5mg IV q5-15min until blood pressure controlled | ||
**Duration of action <1 hour | **Duration of action <1 hour | ||
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*Discharge home if asymptomatic after 4 hours of observation | *Discharge home if asymptomatic after 4 hours of observation | ||
== | ==References== | ||
<references/> | |||
[[Category:Toxicology]] | |||
[[Category: | |||
Latest revision as of 01:13, 24 July 2017
Background
- Occurs when patient taking a monoamine oxidase inhibitor (MAO-I) ingests tyramine
- Tyramine is a dietary amine similar to amphetamine normally metabolized by MAO
- Tyramine is a monoamine and acts indirectly to release catecholamines.
- Tyramine is typically metabolized by monoamine oxidase in the gut, a process that MAOIs interfere with.
- Tyramine is found in preserved meat, fish, cheese, alcohol, and protein-rich foods which are particularly likely to contain bacteria that convert amino acids into monoamines like tyramine.
Clinical Features
- Rapid onset (within 15-90 minutes of ingestion) of:
- Severe occipital or temporal headache
- Sympathomimetic effects: hypertension, diaphoresis, mydriasis, palpitations, chest pain
- Syndrome usually resolves on own over 6 hours
Differential Diagnosis
Hypertension
- Hypertensive emergency
- Stroke
- Sympathetic crashing acute pulmonary edema
- Ischemic stroke
- Intracranial hemorrhage
- Preeclampsia/Eclampsia
- Autonomic dysreflexia
- Scleroderma renal crisis
- Acute glomerulonephritis
- Type- I myocardial infarction
- Volume overload
- Urinary obstruction
- Drug use or overdose (e.g stimulants, especially alcohol, cocaine, or Synthroid)
- Renal Artery Stenosis
- Nephritic and nephrotic syndrome
- Polycystic kidney disease
- Tyramine reaction
- Cushing's syndrome
- Obstructive sleep apnea
- Pheochromocytoma
- Hyperaldosteronism
- Hyperthyroidism
- Anxiety
- Pain
- Oral contraceptive use
Evaluation
- ECG: monitor for cardiac ischemia
- CT head: if patient has focal neurologic findings or persistent, severe headache
Management
- Hypertensive emergency: phentolamine is agent of choice
- 2.5-5mg IV q5-15min until blood pressure controlled
- Duration of action <1 hour
- Beta-blockers contraindicated
Disposition
- Discharge home if asymptomatic after 4 hours of observation