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4-year-old girl died after 12 hours of using metoclopramide ~
case reappeared
child, 4 years old, came to our hospital for emergency treatment due to vomiting for 1 day, paroxysmal convulsions for 11 hours. The child suffered from upper abdominal discomfort due to improper diet 13 hours ago, and non-squirting vomiting. The vomit was stomach contents and there was no fever or convulsions.
was injected with 10 mg of metoclopramide in the local clinic for 2 times; and 5 mg of metoclopramide was taken orally twice. After 2 hours, the child had general body twitches and his eyes rolled upward, which showed a paroxysmal attack, lasting about 6 minutes each time, with varying intervals. After that, the time of each convulsion gradually extended, the interval gradually shortened, and coma occurred, and no medication was given during the period.
body examination: axillary temperature is 37.5℃, the child's complexion is gray, coma, irregular breathing rhythm, nodding and double inhalation, and the pupils on both sides are not as large as the neck; soft neck, phlegm sounds on both lungs, heart rate 70 times/min, smooth and no noise, heart sound is low and dull, the abdomen is normal, the muscle tension on both lower limbs muscles is slightly stronger, and the pathological reflexes are not elicited.
The blood, routine urine and liver function are normal, cerebrospinal fluid is normal, Ca2+, +, Na+, and Cl- are all within the normal range, and are considered to be caused by metoclopramide poisoning.
was immediately given oxygen inhalation and intramuscular injection of 654-2 (anisopamine) 2 mg, 20% mannitol and 50% glucose alternately intravenous injection to reduce intracranial pressure and give sedatives and other treatments. The condition gradually worsened, and respiratory failure was developed, that is, rescue measures such as tracheal intubation and ventilator assisted breathing were performed. In the end, the breathing and heartbeat stopped, and the rescue was ineffective and he died.
metoclopramide is a commonly used antiemetic drug in clinical practice. It has a wide range of indications and is inexpensive. It can be used for vomiting caused by brain tumor surgery, radiotherapy and chemotherapy of tumors, sequelae of brain trauma, acute craniocerebral injury and drugs. It can also treat flatulence indigestion, loss of appetite, belching, and can be used as an auxiliary treatment for biliary diseases and chronic pancreatitis.
On April 24, 2015, CFDA ( State Food and Drug Administration ) issued the "Beware of extrapyramidal reactions caused by metoclopramide", prompting attention to extrapyramidal reactions caused by metoclopramide.
case analysis
substantia nigra pathway has inhibitory dopamine transmitter and excitatory acetylcholine transmitter, which are functionally restricted by each other. When normal, the two are in equilibrium. As a dopamine receptor inhibitor, metoclopramide will cause the removal of the inhibitory effect of substantia nigra on striatal steroids after application, thus showing the advantages of acetylcholine function, resulting in extrapyramidal symptoms.
The liver and kidney function and blood-brain barrier of children are not yet sound, and the nervous system is not well developed, and the response to various stimuli is poor and the response is unstable, resulting in the accumulation of drugs in the body, making it more prone to extrapyramidal reactions.
Methoclopramide injection drug instructions The usage dosage of children in the figure below:
Picture source: Methoclopramide tablets The dosage of children in the figure below:
Picture source: Methoclopramide assistant
Picture source: Methoclopramide assistant
Calculated according to the weight estimation formula, the weight of the 4-year-old child is about 16kg, and the dosage of the child in the case is as high as 30mg within 2 hours, which is obviously excessive. What should nurses deal with the extrapyramidal reaction when
?
1. Always rest in bed, and quickly establish an intravenous channel, give 2-3 L/min oxygen inhalation, and keep the respiratory tract unobstructed;
2. Provide rehydration support to expel poisoned drugs as soon as possible and observe the urine volume at any time;
3. Closely observe vital signs (consciousness, pupils, urine volume, limb tone, etc.);
4. If the condition is serious, antihistamines, anticholiner drugs, benzodiazepines, beta-blocking drugs, and Parkinson's disease drugs can be treated symptomatically. What other uses "minefields" for metoclopramide?
1. Methoclopramide cannot be used in breast cancer patients who vomit due to chemotherapy and radiotherapy.
Reason: Methoclopramide can increase the relative content and activity of estrogen, causing estradiol to overstimulate breast tissue for a long time, causing breast lesions.
Recommendation: Avoid using it for breast cancer patients and switch to serotonin inhibitors. If other antiemetic drugs are not effective or have explosive vomiting, they can be used temporarily.
2. Methoclopramide is ineffective against vomiting caused by motion sickness
Cause: Motion sickness is a syndrome mainly caused by proctite and autonomic nerve reactions, and the main treatment drugs are anticholinergic drugs, antihistamines, etc.
3. Methoclopramide cannot be used in combination with phenothiazines
Reason: Both are used together, and the incidence and severity of extrapyramidal reactions can be increased.
4. Methoclopramide cannot be used in combination with digoxin
Reason: Used together with slow-soluble dosage form digoxin, the gastrointestinal absorption of the latter is reduced, such as taking 2 hours apart can reduce this effect; this product can also increase the bile excretion of digoxin, thereby changing its blood concentration.
5. Methoclopramide cannot be used in patients with digestive tract bleeding. Reasons: gastrointestinal bleeding, mechanical intestinal obstruction or perforation may increase the motivation of the gastrointestinal tract and worsen the condition.
Source: Clinical medicine
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