First generation antipsychotic medication poisoning: Rapid overview of emergency management

To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links).

Rapid overview

Clinical and laboratory features

Cardinal feature of this overdose is CNS depression

Most patients have mild tachycardia; occasional patients have additional features of the anticholinergic toxidrome

Acute extrapyramidal syndromes (eg, acute dystonic reactions, akathisia) are uncommon in overdose

Pupils may be any size

QT prolongation is common but Torsade de Pointes (TdP) is rare

Diagnostic evaluation

No specific laboratory testing is required

Obtain an ECG to evaluate for QT prolongation

Rule out other causes of depressed mental status (eg, hypoglycemia, intracranial lesion) as clinically indicated

Rule out common coingestions (eg, aspirin, acetaminophen) and others as clinically indicated

Treatment

No specific antidote exists; treatment is supportive

Acute extrapyramidal syndromes can be treated with antimuscarinic medications (diphenhydramine or benztropine) or benzodiazepines

For patients with significant QT prolongation:

Monitor the ECG until the QTc is <500 msec and trending toward improvement
Correct significant electrolyte abnormalities, particularly hypokalemia
Avoid giving medications that further prolong the QT interval

Graphic 64216 Version 10.0

خرید پکیج

First generation antipsychotic medication poisoning: Rapid overview of emergency management