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Dystonic Reaction, Emergency Medicine

Kenneth Jackimczyk Reviewed 06/2017
 


Basics

Description

  • Normal pattern of CNS neurotransmission maintained by balance between dopaminergic and cholinergic receptors:

    • Certain drugs antagonize dopamine receptors in the basal ganglia resultin...

Diagnosis

Signs and Symptoms

History

  • Ingestion of neuroleptic, antiemetic, or other drug within week of symptom onset

    • May occur in patients on neuroleptic agents who increase their dose of neuroleptics o...

Treatment

Pre-Hospital

  • Rarely life threatening

  • Direct attention toward spasm of larynx and tongue to be sure dystonic reaction is not causing respiratory compromise

  • Ask family and friends about ingestion...

Follow-Up

Disposition

Admission Criteria

  • Patients are not admitted unless symptoms do not resolve with treatment, there are concerns about maintaining the airway, or the diagnosis is not certain

  • If the d...

Pearls and Pitfalls

  • The diagnosis of acute dystonia is made based on the history of ingestion coupled with complete resolution of the symptoms after appropriate treatment

  • 1st line of therapy is diphenh...

Additional Reading

  • Derinoz  O, Caglar  AA. Drug-induced movement disorders in children at paediatric emergency department: ‘Dystonia’. Emerg Med J.  2013;30:130–133.

  • Goldfrank  LR, Lewin  NA, Howl...

Codes

ICD9

333.72 Acute dystonia due to drugs 

ICD10

  • G24.01 Drug induced subacute dyskinesia

  • G24.02 Drug induced acute dystonia

  • G24.09 Other drug induced dystonia

  • G24.0 Drug induced dystonia

SNOMED

  • 230315008 ...

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