Presentation
Patients presenting with dystonias were more likely to have extensive diagnostic testing for neurologic disease than those presenting without dystonias. [tandfonline.com]
In one case in the study phenothiazine intoxication was present in the newborn infant of a schizophrenic mother. [ncbi.nlm.nih.gov]
Patients with salicylate poisoning are often alkalemic on presentation with hyperventilation. [calpoison.org]
Present on Admission symbol identifies the diseases that will always be coded as present on admission. Manifestation code identifies conditions for which it is important to record both the etiology and the symptom of the disease. [books.google.com]
Diagnosis is often made in patients presenting with symptoms referrable to the neurological system with a known history of phenothiazine consumption. [medscape.com]
Entire Body System
- Hypothermia
Toxidromes "A pattern of signs or symptoms that suggests a specific class of poisoning" Opioids triad of respiratory depression, pinpoint pupils, decreased LOC bradycardia, hypotension, hypothermia needle tracks Sedative / Hypnotics - benzodiazepines, [mcgill.ca]
Rapid sunburn if exposed to the sun Skin discoloration, bluish (changing to purplish) Stomach and intestinal tract: Constipation Loss of appetite Nausea Other: Changes in menstrual pattern (in women, from chronic doses) Fever Low body temperature (hypothermia [indiatoday.intoday.in]
Temperature - hypothermia (phenothiazines, barbiturates, or tricyclics) or hyperthermia (amfetamines, ecstasy, MAOIs, cocaine, antimuscarinics, theophylline, serotonin syndrome). Muscle rigidity (ecstasy, amfetamines). [patient.info]
TOXIDROMES Opioids • Triad: respiratory depression, PPP, decreased level of consc • Bradycardia, hypotension, hypothermia Cholinergics: carbamate and organophosphate • SLUDGE • Seizures, coma • Muscle fasciculations • Miosis Serotonin Syndrome: fluoxetine [slideshare.net]
[…] short-term adjunctive management of anxiety, psychomotor agitation, excitement, and violent or dangerously impulsive behaviour; intractable hiccup; nausea and vomiting of terminal illness (where other drugs have failed or are not available); induction of hypothermia [inchem.org]
- Anemia
[…] right away if any of these rare but serioussigns of liver problems (such as yellowing eyes /skin, persistent nausea, vomiting, stomach / abdominal pain ), signs of infection (such as fever, persistent sore throat ), easy bruising/bleeding, signs of anemia [webmd.com]
View all 31 references Phenothiazines may infrequently cause hematologic toxicity, including agranulocytosis, thrombocytopenia, eosinophilia, aplastic anemia, purpura, granulocytopenia, and hemolytic anemia. [drugs.com]
Blood Dyscrasias: Agranulocytosis, leukopenia, eosinophilia, thrombocytopenia, anemia, aplastic anemia, pancytopenia. Allergic Reactions: Fever, laryngeal edema, angioneurotic edema, asthma. Hepatotoxicity: Jaundice, biliary stasis. [rxlist.com]
- Pathologist
Covered By The Guidance This pathway provides guidance on the imaging surveillance of adult patients with subsolid pulmonary Tissue pathways for urological pathology The target primary users of the tissue pathway are trainee and consultant cellular pathologists [evidence.nhs.uk]
Cardiovascular
- Hypotension
Complication Phenothiazine Antipsychotic Drug Poisoning Complications Complications of arrhythmia and hypotension Cardiovascular system mainly manifested as tachycardia and other arrhythmia, hypotension and even shock. [healthfrom.com]
Resuscitation: Reduced GCS: Prompt intubation and ventilation Hypotension: Give 10 – 20 ml/kg of IV crystalloid, if response is not adequate start noradrenaline ( adrenaline is contraindicated due to paradoxical hypotension from beta 2 mediated vasodilatation [lifeinthefastlane.com]
Hypotension has rarely presented a problem with fluphenazine, however, patients with phaeochromocytoma, cerebral vascular insufficiency, or a severe cardiac reserve deficiency such as mitral insufficiency appear to be particularly prone to hypotensive [home.intekom.com]
HYPOTENSION Hypotension should be managed by the administration of intravenous fluids and by physical means. [inchem.org]
Other toxic effects include bloody stools and vomitus, hypotension, shock, seizures, and coma. Heart failure is the usual cause of death. [glowm.com]
Musculoskeletal
- Torticollis
[…] poisoning caused by rare, and the side effects of treatment are more Common for the extrapyramidal reaction, the clinical can be seen in the following three categories: tremor paralysis syndrome; sit still (akathisia); acute tension disorders such as torticollis [healthfrom.com]
Extrapyramidal Symptoms: Akathisia, agitation, motor restlessness, dystonic reactions, trismus, torticollis, opisthotonus, oculogyric crises, tremor, muscular rigidity, akinesia. [rxlist.com]
These reactions are characterized by spastic contraction of discrete muscle groups and may include torticollis, opisthotonos, carpopedal spasm, trismus, difficulty swallowing, perioral spasms with protrusion of the tongue, and oculogyric crisis. [drugs.com]
Psychiatrical
- Delusion
Multimedia: Slideshows, Images & Quizzes Related Disease Conditions Schizophrenia Schizophrenia is a disabling brain disorder that may cause hallucinations and delusions and affect a person's ability to... [medicinenet.com]
[…] stupor, coma, slurred speech respiratory depression variable pupil changes hypotension hypothermia barbiturate blisters Sympathemimetics / Withdrawal - Cocaine, amphetamines, PCP, pseudoephedrine HTN, tachycardia, Mydriasis Anxiety, delirium, paranoid delusions [mcgill.ca]
Neurologic
- Tremor
Schwab Medicine The New England journal of medicine 1961 It has become clear that tremor and rigidity may be significantly altered by lesions in the mesial aspect of the globus pallidus, the ventrolateral nucleus of the thalamus and the substantia nigra [semanticscholar.org]
Tell your doctor right away if you notice any of the following side effects: feelings of anxiety /agitation/jitteriness, drooling/trouble swallowing, restlessness/constant need to move, shaking (tremor), shuffling walk, stiff muscles, severe muscle spasms [webmd.com]
[…] the daily amount can be as small as 20 ~ 30mg, up to 1 ~ 2g, so excessive fatal poisoning caused by rare, and the side effects of treatment are more Common for the extrapyramidal reaction, the clinical can be seen in the following three categories: tremor [healthfrom.com]
[…] movements) NERVOUS SYSTEM Agitation, irritability, confusion Convulsions (seizures) Disorientation, coma (lack of responsiveness) Drowsiness Fever Low body temperature Restlessness linked with repeated foot shuffling, rocking, or pacing (akathisia) Tremor [medlineplus.gov]
[…] neck, face, and back Muscle stiffness Nervous system: Agitation Clumsiness Coma Confusion Convulsions Deep sleep Difficulty walking or shuffling gait Fainting Hallucinations (rare) Uncoordination Irritability Needing to move, restlessness (dystonia) Tremor [indiatoday.intoday.in]
- Involuntary Movements
movements of the face (chewing, blinking, grimaces, and tongue movements) NERVOUS SYSTEM Agitation, irritability, confusion Convulsions (seizures) Disorientation, coma (lack of responsiveness) Drowsiness Fever Low body temperature Restlessness linked [medlineplus.gov]
References Oyewumi LK, Lapierre YD, Gray R, Batth S, Gelfand R "Abnormal involuntary movements in patients on long-acting neuroleptics." [drugs.com]
The syndrome is characterised by rhythmical involuntary movements of the tongue, face, mouth or jaw (e.g. protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements). [home.intekom.com]
movements of the tongue, face, jaw, or mouth) (Rosenberg & Green 1989). [inchem.org]
- Opisthotonus
Central Nervous System : The side effects most frequently reported with phenothiazine compounds are extrapyramidal symptoms including pseudo-parkinsonism, dystonia, dyskinesia, akathisia, oculogyric crises, opisthotonus, and hyperreflexia. [home.intekom.com]
[…] agitation, AMS hyperreflexia, tremor, myoclonus, trismus ataxia, incoordination flushing,diaphoresis diarrhea fever Difficult to distinguish from NMS, MH, cocaine intoxication, thyroid storm Extrapyramidal haloperidol, phenothiazines rigidity, tremor opisthotonus [mcgill.ca]
[…] fluoxetine, trazadone, meperidine • Irritability, agitation, altered mental status • Hyperreflexia, tremor, myoclonus, trismus • Ataxia, incoordination • Flushing, diaphoresis, fever • Diarrhea Extrapyramidal: haloperidol, phenothiazines • Rigidity, tremor • Opisthotonus [slideshare.net]
Extrapyramidal Symptoms: Akathisia, agitation, motor restlessness, dystonic reactions, trismus, torticollis, opisthotonus, oculogyric crises, tremor, muscular rigidity, akinesia. [rxlist.com]
- Choreoathetoid Movements
The syndrome is characterized by involuntary choreoathetoid movements which variously involve the tongue, face, mouth, lips, or jaw (e.g., protrusion of the tongue, puffing of cheeks, puckering of the mouth, chewing movements), trunk, and extremities. [rxlist.com]
Workup
Serum
- Hyperprolactinemia
Ristic PI, Ory SJ, Lurain JR "Endometrial adenocarcinoma associated with drug-induced hyperprolactinemia." Obstet Gynecol 67 (1986): s86-8 Gift T, Plum K, Price M "Depot fluphenazine and plasma prolactin." [drugs.com]
Treatment
Treatment Treatment of Phenothiazine Antipsychotic Drug Poisoning Departments: Other departments of the emergency department Treatment: drug treatment supportive treatment Treatment cycle: 4-8 weeks Cure rate: 60% -75% Commonly used drugs: bumetanil tablets [healthfrom.com]
[…] problems for which specific treatments are available. [rxlist.com]
Pathophysiology is emphasized throughout, providing a sound basis for discussions of the diagnosis, treatment, and prognosis that follow. [books.google.de]
As outpatient treatment of schizophrenia increases, cases of over-dose with phenothiazine drugs may be expected to increase also. [ncbi.nlm.nih.gov]
Prognosis
Pathophysiology is emphasized throughout, providing a sound basis for discussions of the diagnosis, treatment, and prognosis that follow. [books.google.de]
The prognosis of Phenothiazine Overdose is dependent on the amount of drug consumed, time between overdose and treatment, severity of the symptoms, as well as general health status of the patient If the individual can recover from the symptoms within [dovemed.com]
[…] excess In vitro symptoms, high doses of poisoning after a coma, respiratory depression, but the body twitch is rare, the patient vomit, gastric lavage and urine poison analysis and blood drug concentration determination, are helpful in diagnosis and prognosis [healthfrom.com]
Blood and urine tests Breathing support X-rays EKG (electrocardiogram, or heart tracing) Intravenous (through the vein) fluids Laxative Medication (antidote) to reverse the effects of the drug Tube placed down the nose and into the stomach Outlook (Prognosis [indiatoday.intoday.in]
Etiology
Etiology Phenothiazine antipsychotic drug poisoning etiology Patients with excessive phenothiazine antipsychotic drugs cause poisoning. [healthfrom.com]
Manifestation code identifies conditions for which it is important to record both the etiology and the symptom of the disease. [books.google.com]
Lithium, one of the oldest mood stabilizers, has been reported to cause eye irritation during the first few weeks of treatment. 12 A potential etiology may be an increased sodium concentration in lacrimal secretion due to lithium’s effects on sodium-chloride [reviewofoptometry.com]
Epidemiology
Objective: To describe the presentation, epidemiology, management, and outcome of phenothiazine and butyrophenone ingestions in children requiring hospitalization. Method: Retrospective case series in two pediatric hospitals. [tandfonline.com]
Epidemiology Drugs and toxins that act as sodium channel antagonists include agents listed in List 1. Together they comprise perhaps the largest group of cardiotoxic agents. [calpoison.org]
Epidemiology In 2012, 110,960 self-harm cases were admitted to NHS hospitals in Englnd in the 12 months to August 2012 - a 0.4 per cent increase on the previous 12-month period (110,490). [ 1 ] In England and Wales, between 2013 and 2014, accidental poisonings [patient.info]
Neither clinical studies nor epidemiologic studies conducted to date, however, have shown an association between chronic administration of these drugs and mammary tumorigenesis; the available evidence is considered too limited to be conclusive at this [rxlist.com]
Abuses Epidemiology Although the phenothiazines show similar toxic properties to the tricyclic antidepressants, overdoses tend to be less serious, with severe hypotension and cardiotoxicity being less common. (Ellenhorn 1997). [inchem.org]
Pathophysiology
Pathophysiology is emphasized throughout, providing a sound basis for discussions of the diagnosis, treatment, and prognosis that follow. [books.google.de]
References DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999): "Product Information. Compazine (prochlorperazine)." [drugs.com]
Pathophysiology The role of sodium bicarbonate as an antidote depends on the specific indication. Its mechanisms as an antidote for sodium channel blocking drugs are incompletely understood. [calpoison.org]
Prevention
Prevention Phenothiazine Antipsychotic Drug Poisoning Prevention 1. The use of such drugs in psychiatric patients, need to instruct their families to monitor medication. 2. Master the indications and dosages, do not abuse. 3. [healthfrom.com]
To prevent poisoning it is important to use and store products exactly as their labels say. Keep dangerous products where children can't get to them. Treatment for poisoning depends on the type of poison. [icdlist.com]
Serum alkalinization may prevent distribution into the central nervous system. Urinary alkalinization will ionize the drug in the urine preventing resorption by the kidneys back into the blood, thus enhancing toxin elimination. [calpoison.org]
Prevention Keep all medications in childproof containers out of the reach of children. References Nockowitz RA, Rund DA. Psychotropic medications. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. [indiatoday.intoday.in]