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Neuroleptic Poisoning, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Neuroleptics (antipsychotics) used for management of:

    • Psychotic disorders

    • Agitation

    • Dementia in the elderly

    • Autism and behavioral problems in children

    • Eating disorders

    • Antiemetic

    • Migraine h...

Diagnosis

Signs and Symptoms

  • Acute overdose:

    • Symptom onset within 6 hr, 9 hr with aripiprazole, up to 24 hr with extended-release formulations (paliperidone)

    • Can be delayed if anticholinergic symptoms pr...

Treatment

Pre-Hospital

Bring medication bottles when transporting patient to hospital. 

Initial Stabilization/Therapy

Airway, breathing, and circulation management (ABCs): 
  • Administer supplemental oxygen.

  • ...

Follow-Up

Disposition

Admission Criteria

  • Overdose with CNS sedation, agitation, dysrhythmias, or vital sign abnormalities to monitored bed or ICU

  • NMS require ICU care

  • New-onset diabetes (secondary to neur...

Pearls and Pitfalls

  • Neuroleptics represent a group of drugs with diverse indications and a wide range of toxicity.

  • Most overdoses are mild, and CNS depression predominates.

  • Dystonic reactions are the mo...

Additional Reading

  • Levine  M, Ruha  AM. Overdose of atypical antipsychotics: Clinical presentation, mechanisms of toxicity and management. CNS Drugs.  2012;26:601–611.

  • Lipscombe  LL, Lévesque  L, ...

Codes

ICD9

  • 969.1 Poisoning by phenothiazine-based tranquilizers

  • 969.2 Poisoning by butyrophenone-based tranquilizers

  • 969.3 Poisoning by other antipsychotics, neuroleptics, and major tranquilizers

  • 333.92 N...

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