Dexmedetomidine as an Adjunct to Treat Anticholinergic Toxidrome in Children

Cowan, Krista; Landman, Rebecca A.; Saini, Arun

doi:10.1177/2333794x17704764

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…Dexmedetomidine's utility in anticholinergic toxicity has been demonstrated in nine prior pediatric cases [8][9][10]12]. The two cases we present support this growing literature and include the youngest case reported to date.…”

Section: Discussionsupporting

confidence: 72%

“…Thus, safe alternative therapies are needed. Though there are few case reports pointing toward dexmedetomidine's utility in anticholinergic and more complex mixed presentations, literature is limited in pediatrics to support its role in ingestions with suspected anticholinergic toxidrome [2,[8][9][10][11][12]. We report two cases of suspected polysubstance overdose presenting with primary anticholinergic side effects in which traditional therapeutic strategies were either contraindicated or ineffective, while treatment with dexmedetomidine was rapidly efficacious with no adverse effects.…”

Section: Introductionmentioning

confidence: 91%

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The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome

Zekhtser

Carroll

Boyd

et al. 2021

Case Reports in Critical Care

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Background. We report two pediatric cases of anticholinergic toxidrome, including the youngest reported to date, in which standard therapeutic strategies were either contraindicated or ineffective, while treatment with dexmedetomidine was rapidly efficacious with no adverse effects. Moreover, with the recent shortage of physostigmine, we highlight an alternative treatment in this clinical setting. Case Summaries. In case 1, a two-year-old had an overdose presenting with an anticholinergic toxidrome. However, his hypopnea precluded the use of benzodiazepines due to the high likelihood of intubation. In case 2, a 14-year-old had a polypharmacy overdose inducing agitated delirium that was refractory to high-dose benzodiazepines. Due to the unknown ingestion, physostigmine was avoided. In both cases, dexmedetomidine helped the patient remain calm and metabolize the ingestions. Conclusion. Our experience suggests that dexmedetomidine may be a useful adjunct in anticholinergic presentations in the setting of polypharmacy, when standard therapy is proven ineffective, contraindicated, or unavailable.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 91%

The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome

Zekhtser

Carroll

Boyd

et al. 2021

Case Reports in Critical Care

View full text Add to dashboard Cite

show abstract

“…Morphine's analgesic activity is mainly associated with this latter metabolite, a strong μ-receptor agonist with a higher affinity than morphine itself (Paul et al 1989). Considering the activity of the cytochrome P450 2D6, the entire world population could be divided into three groups: poor metabolizers (PM), extensive metabolizers (EM) and ultra-rapid metabolizers (UM) (Cowan, Landman, and Saini 2017). These differ in the ratio of codeine metabolized into morphine: Persons with the PM phenotype convert about 10% of codeine to morphine, while those with EM about 40% of codeine, and those with UM convert about 51%.…”

Section: The Chemistry Of Purple Drankmentioning

confidence: 99%

“Purple Drank” (Codeine and Promethazine Cough Syrup): A Systematic Review of a Social Phenomenon with Medical Implications

Miuli

Stigliano

Lalli

et al. 2020

Journal of Psychoactive Drugs

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In the early 1990s, several studies reported the misuse of codeine and promethazine hydrochloride cough syrup. Since then, the combination of this pharmaceutical, together with sprite or alcohol, known on the streets as "purple drank" or "lean", has become a popular drug among rap singers who promote its tranquilizing and euphoric effects through their music and videos. This review examines the "purple drank" phenomenon, taking into consideration its clinical and social implications. The study was conducted using PubMed, Scopus, and Web of Science as search engines, applying several inclusion and exclusion criteria and the string "Purple AND drank", resulting in 138 records. Seven papers that met our criteria were found. The risk of bias assessment, when applicable, was also considered, resulting in a low level of risk. Epidemiological data highlighted a heterogeneous diffusion of the misuse of this mixture, which is not exclusively linked to a specific type of user (African-American teenagers, athletes, and rappers), as previously reported in American newspapers and in the social media. New digital tools should be taken into consideration for further social and medical evaluations of this phenomenon.

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“…14 Several studies indicate anticholinergic drugs as risk factors for delirium and the role of anticholinergic burden in delirium pathophysiology. 5,[14][15][16][17] Anticholinergic toxidrome is described after exposure to anticholinergic drugs, including H2 blockers, 16,17 which antagonize peripheral and central muscarinic receptors, producing anticholinergic toxoids. One CNS manifestation of these drugs is delirium.…”

Section: Figurementioning

confidence: 99%

Ranitidine-Induced Delirium in a 7-Year-Old Girl: A Case Report

et al. 2019

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Ranitidine is a histamine-2 blocker commonly prescribed in PICUs for the prophylaxis of gastrointestinal bleeding and stress ulcers. However, it can be associated to central nervous system side effects, such as delirium, in adults. We present the first case of a child presenting delirium possibly caused by anticholinergic toxidrome secondary to the use of ranitidine, resolving after drug discontinuation. With this case report, we reinforce that a wide variety of clinical conditions can trigger delirium and that the best therapeutic approach is to minimize risk factors.

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Dexmedetomidine as an Adjunct to Treat Anticholinergic Toxidrome in Children

Cited by 4 publications

References 13 publications

The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome

The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome

“Purple Drank” (Codeine and Promethazine Cough Syrup): A Systematic Review of a Social Phenomenon with Medical Implications

Ranitidine-Induced Delirium in a 7-Year-Old Girl: A Case Report

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