Acute Dystonic Reaction in a 14-Year-Old Boy after Accidental Overuse of Nasal Metoclopramide

Abstract

We present the case of a 14-year-old boy who developed an acute dystonic reaction 5 h following the overuse of a nasal metoclopramide spray that his mother gave him thinking it was a nasal decongestant. The patient had torticollis and intense motor restlessness, while he was fully conscious and hemodynamically stable. All laboratory investigations were normal. He was treated with a single dose of biperiden intravenously with direct disappearance of the symptoms. Children are particularly susceptible to the extrapyramidal side effects of metoclopramide that can occur irrespective of the route of administration.

Acute Oromandibular Dystonia

“…Acute dystonic reactions may represent a challenging diagnosis in the emergency room, as there is a high probability of misdiagnosis with other conditions like tetanus, partial seizures, encephalitis, meningitis or allergic reactions. 5,9 In our case, besides the dystonia, the adolescent also presented angioedema that resolved after treatment. This finding is uncommon but has yet been described either with metoclopramide or other drugs such as haloperidol.…”

“…3 Acute dystonia typically occurs within 24 to 48 hours of initiating treatment and includes opisthotonus, torticollis, oculogyric crises and tonic muscular contractions. 4,5 Pharyngeal muscle spasms or laryngospasm are rare but potentially life-threatening. 6,7 Neurological adverse effects of metoclopramide are idiosyncratic and are not dose dependent, although it is more frequent with higher doses.…”