Ergotism

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Background

  • Long term effects of ergotamine usage or ergot poisoning
  • Coadministration of ergotamine medication with triptan or certain antibiotics
  • Increase in serotonin activity
  • α-adrenergic agonist activity peripherally

Clinical Features

  • Usage of ergotamines such as dihydroergotamine (DHE) and methylergometrine (Methergine)
  • Miosis
  • Burning sensation in extremities
  • Cerebrovascular ischemia
  • Seizures
  • Cardiac ischemia
  • GI disturbances
  • Peripheral ischemia

Differential Diagnosis

  • Atypical migraine
  • CVA

Workup

Management

  • Intake within 2 hours
    • Considered activated charcoal
    • Consider definitive airway
  • Mild ergotism
    • IVF
    • Antiemetic
    • Analgesia
  • Severe Peripheral Vasoconstriction or Ischemia
    • Vasodilators - nitroprusside, nitroglycerine
    • Consider corticosteroids
    • Consider heparinization

Disposition

  • Consider obs for mild ergotism
  • Admission for severe ergotism

See Also

External Links

References

Goldfrank"s Toxicologic Emergencies, 9th Ed. Pgs 705-706, 763-769, and 1060-1064.