Dystonija caused with metoklopramid in emergency medical service: Case report

Abstract

Introduction: Metoclopramide is commonly prescribed drug for treatment of nausea and vomiting. Acute dystonic reaction is the most common adverse effect and occur at approximately 0.2% of population. Material: Data from original medical reports and the hospital discharge summary were used. Material: Retrospective study of the work of one physician in the City Institute for EMS Belgrade in the period from 2017 to 2018 involving 2481 patients. Case report: In November 2019, the parents brought a thirteen year old child in the EMS. The child had vomited for 3 days and his parents gave him 2 tablets of metoclopramide, 24h after the pill ingestion the child began to cramping. During the examination, the patient was fully consciousness and upset, with a noticeable trismus, oculogyric reaction, torticollis, tongue protrusion and dysphonia. Vital signs at admission: BP 100/60 mmHg, HR 120/minute, SpO2 98%, blood glucose level 5.6 mmol/l. ECG noted signs of sinus tachycardia. The patient was transported to the hospital, with the i.v infusion of 500ml 0.9% NaCl solution and with oxygen support of 3l/min. According to the medical documentation, the patient was hospitalized and treated with i.v. Diazepam and saline infusions. Two days after hospitalization, the patient was released home in a stable condition. Conclusion: We must be careful with an uncritically usage of metoclopramide because of possible extrapyramidal side effect. Drug induced dystonia is a potentially life-threatening condition, and it is important to recognize and timely take care of such a condition in EMS.