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Phenothiazine Poisoning

Poisoning by Phenothiazine Based Tranquilizer


Presentation

  • In one case in the study phenothiazine intoxication was present in the newborn infant of a schizophrenic mother.[ncbi.nlm.nih.gov]
  • 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]
  • Patients with salicylate poisoning are often alkalemic on presentation with hyperventilation.[calpoison.org]
  • From the data presented it seems that the level of this kind of drugs in the liver can be of value for evaluting the severity of intoxication. The blood values often reflect levels after the maximum concentration has been passed.[link.springer.com]
  • Similarly, the analysis should not end after the first positive result, since additional unsuspected compounds may be present.[who.int]
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]
Multiple Organ Dysfunction Syndrome
Myopathy
  • […] resistance to phagocytosis, and host substrate utilization New information on changes in body weight Recent findings on fibrocoxib and diclofenac Expanded and reorganized coverage of critical care New material on inborn errors of metabolism and acquired myopathies[books.google.de]
Psychiatric Symptoms
  • Antipsychotics (antipsychotics) refers to the treatment of various types of mental illness and various psychiatric symptoms of drugs, also known as strong stabilizer or nerve blockers.[healthfrom.com]
Opisthotonus
  • […] 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]
  • 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]
  • […] 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]
Ocular Bobbing
  • Reverse ocular bobbing due to combined phenothiazine and benzodiazepine poisoning. Statistics from Altmetric.com This is a PDF-only article. The first page of the PDF of this article appears above.[jnnp.bmj.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]
  • As outpatient treatment of schizophrenia increases, cases of over-dose with phenothiazine drugs may be expected to increase also.[ncbi.nlm.nih.gov]
  • Pathophysiology is emphasized throughout, providing a sound basis for discussions of the diagnosis, treatment, and prognosis that follow.[books.google.de]
  • The antihistamines are becoming increasingly popular in a variety of non-prescription formulations, including sleep-aids, hay fever treatments and cough and cold remedies.[journals.rcni.com]

Prognosis

  • Pathophysiology is emphasized throughout, providing a sound basis for discussions of the diagnosis, treatment, and prognosis that follow.[books.google.de]
  • […] 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]
  • 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]
  • 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

  • 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]
  • Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies.[drugs.com]
Sex distribution
Age distribution

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]

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