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Phenothiazine Poisoning

Phenothiazines Toxicity


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]
Antipsychotic Agent
  • The previous antipsychotic agent should be administered concurrently for 3 days, and then discontinued.[home.intekom.com]
  • agent, 055174, 人工移植物, ジンコウイショクブツ, artificial implant, 055202, 人工臓器, ジンコウゾウキ, artificial organ, 002543, 生体代行装置, セイタイダイコウソウチ, artificial biosystem, 014900, 装置, ソウチ, equipment, 004354[togodb.biosciencedbc.jp]
  • Antipsychotic agents. In: Shannon MW, Borron SW, Burns MJ. Haddad and Winchesters Clinical Management of Poisoning and Drug Overdose. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 38. Review Date: 10/15/2013 Reviewed By: Jacob L.[indiatoday.intoday.in]
  • agents have been associated with higher risk of cerebrovascular accidents. 34 Statistically significant risk has not been noted with atypical medications and seems to dissipate with discontinuation. 34 Dr.[reviewofoptometry.com]
  • Thioridazine is a phenothiazine antipsychotic agent known to cause a pigmentary retinopathy. While its use in the United States has declined over the years, recent case reports still have described toxicity due to both acute 16 and long-term 17 use.[retinalphysician.com]
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
Malnutrition
  • Nutrition in CKD : 5th edition [PDF] Malnutrition in chronic kidney disease (CKD) is common but is often undiagnosed. This evidence-based clinical practice guideline summarises the main interventions that may be recommended in the...[evidence.nhs.uk]
Cough
  • 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]
  • Tell your doctor right away if any of these unlikely but serious side effects occur: difficulty urinating, decreased cough reflex, swelling of the feet/ ankles, butterfly-shaped rash on nose and cheeks, joint pain, skin discoloration, eye / vision changes[webmd.com]
  • . • Ipecac syrup may be used in small amounts as an expectorant in cough preparations; however, this use has doubtful therapeutic benefit. • Drug may be abused by patients with eating disorders such as bulimia or anorexia nervosa.[glowm.com]
Tachypnea
  • Unexplainable tachypnea and paradoxical miosis were noted in severe cases. In one case in the study phenothiazine intoxication was present in the newborn infant of a schizophrenic mother.[ncbi.nlm.nih.gov]
  • Respiratory compensation with tachypnea may occur while the parent alcohols are metabolized to the respective organic acid metabolites.[calpoison.org]
  • ,carbamate, organophosphates, nerve gas, physostigmine Salivation, Lacrimation, Urination, Defecation, Gastric cramping, Emesis SLUDGE Drowning in secretions, profuse sweating AMS, seizures, coma Muscle fasciculations Miotic pupils Salicylates fever tachypnea[mcgill.ca]
Dysphagia
  • Symptom Phenothiazines antipsychotic drugs poisoning symptoms common symptoms paralysis coma twitch striatal dermatitis dysphagia bowel movements reduce body temperature regulation disorders As a result of this type of drug treatment dose of a large range[healthfrom.com]
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]
Orthostatic Hypotension
  • ., in addition to the treatment process there are orthostatic hypotension, temperature disorder, allergic to chlorpromazine drugs, even if the treatment dose also caused exfoliation Dermatitis, granulocytic deficiency and cholestatic hepatitis.[healthfrom.com]
  • If you think how you use these drugs in an aggressive patient you will understand their effects in overdose for a spectrum of CNS depression, orthostatic hypotension, anticholinergic effects and rarely dystonia.[lifeinthefastlane.com]
  • Medications, particularly benzodiazepines, phenothiazines and anti-depressants, have been implicated as a risk factor for falls in patients with dementia [1, 3, 4, 11, 12], via the proposed mechanisms of central sedation, orthostatic hypotension and extra-pyramidal[medical-dictionary.thefreedictionary.com]
  • Patients who experience orthostatic hypotension should be cautioned not to rise too abruptly. Occasionally, when severe, hypotension may require treatment with vasoconstrictive agents such as norepinephrine or phenylephrine.[drugs.com]
  • Female patients appear to have a greater tendency to orthostatic hypotension than male patients.[rxlist.com]
Dermatitis
  • Symptom Phenothiazines antipsychotic drugs poisoning symptoms common symptoms paralysis coma twitch striatal dermatitis dysphagia bowel movements reduce body temperature regulation disorders As a result of this type of drug treatment dose of a large range[healthfrom.com]
  • […] successfully treated with antihistamines. 2,3 In a review of phenothiazine toxicity in children these were the major side effects mentioned. 4 Phenothiazines can also produce the dangerous hypersensitivity reactions of agranulocytosis, hepatitis, and dermatitis[pediatrics.aappublications.org]
  • Drug-induced photosensitivity occurs when certain photosensitising medications cause unexpected sunburn or dermatitis (a dry, bumpy or blistering rash ) on sun- exposed skin (face, neck, arms, backs of hands and often lower legs and feet).[dermnetnz.org]
  • Cutaneous Reactions: Erythema, exfoliative dermatitis, contact dermatitis. Blood Dyscrasias: Agranulocytosis, leukopenia, eosinophilia, thrombocytopenia, anemia, aplastic anemia, pancytopenia.[rxlist.com]
  • Inhalation Dermal Contact dermatitis. Ocular Other routes BY INJECTION: as for acute ingestion.[inchem.org]
Miosis
  • Unexplainable tachypnea and paradoxical miosis were noted in severe cases. In one case in the study phenothiazine intoxication was present in the newborn infant of a schizophrenic mother.[ncbi.nlm.nih.gov]
  • The physician should be aware that the following have occurred with one or more phenothiazines and should be considered whenever one of these drugs is used: Autonomic Reactions: Miosis, obstipation, anorexia, paralytic ileus.[rxlist.com]
  • 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]
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]
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]
Muscle Twitch
  • Infrequently, this medication may cause face/muscle twitching and uncontrollable movements ( tardive dyskinesia ). In some cases, this condition may be permanent.[webmd.com]
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]
Akathisia
  • […] 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 paralysis syndrome; sit still (akathisia[healthfrom.com]
  • Metoclopramide appears to result in roughly the same incidence of acute dystonic reactions, akathisia, or hypotension as the phenothiazines.[medical-dictionary.thefreedictionary.com]
  • Extrapyramidal Symptoms: Akathisia, agitation, motor restlessness, dystonic reactions, trismus, torticollis, opisthotonus, oculogyric crises, tremor, muscular rigidity, akinesia.[rxlist.com]
  • 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]
  • Clinical Features Features - acute Ingestion Hypotension, sinus tachycardia, varying degrees of CNS depression, blurred vision, dry mouth, urinary retention, acute dystonic reactions, akathisia, parkinsonism, ECG changes including prolonged PR and QT[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]
  • Extrapyramidal Symptoms: Akathisia, agitation, motor restlessness, dystonic reactions, trismus, torticollis, opisthotonus, oculogyric crises, tremor, muscular rigidity, akinesia.[rxlist.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]
Stroke
  • Keep current with the latest developments in palliative care, mass casualty/epidemic disease, acute respiratory failure, non-invasive ventilation, neurocritical care, neuroimaging, hypoxic-ischemic encephalopathy, stroke and intracerebral hemorrhage,[books.google.de]
  • Stroke/subarachnoid haemorrhage. Meningitis. Metabolic abnormalities (such as hypoglycaemia, hyponatraemia, or hypoxaemia). Liver disease.[patient.info]
  • Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system (CNS) pathology.[rxlist.com]
  • […] otherwise administered cautiously in patients with severe cardiovascular disease, pheochromocytoma, a predisposition to hypotension, or conditions that could be exacerbated by hypotension such as a history of myocardial infarction, angina, or ischemic stroke[drugs.com]
Encephalopathy
  • Keep current with the latest developments in palliative care, mass casualty/epidemic disease, acute respiratory failure, non-invasive ventilation, neurocritical care, neuroimaging, hypoxic-ischemic encephalopathy, stroke and intracerebral hemorrhage,[books.google.de]
  • . • It is water soluble and may be used IM or IV • It allows extracellular lead to be renally eliminated • In cases of lead encephalopathy, BAL should be given first to avoid redistribution of lead mobilized by CaNa2EDTA to CNS. • 3- D-Penicillamine:[slideshare.net]
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

Prolonged QT Interval
  • QT interval. [6] Metabolic syndrome, most commonly related to long-term olanzapine and clozapine use, is associated with weight gain, diabetes, and cardiovascular disease.[emedicine.medscape.com]
  • Subsequent ventricular tachycardia responded to intravenous lignocaine, and a prolonged QT interval shortened progressively to normal over the next three days (Reid & Harrower 1984).[inchem.org]

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]
  • 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]
  • Treatment for poisoning depends on the type of poison. If you suspect someone has been poisoned, call your local poison control center at 1-800-222-1222 right away.[icdlist.com]
  • Focus on the development, function, and treatment of a wide range of disease entities with the text’s clear, logical, organ-system approach.[books.google.de]

Prognosis

  • […] 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

  • 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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