Clonidine toxicity: Difference between revisions

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**Naphazoline (Naphcon)
**Naphazoline (Naphcon)
**Apraclonidine
**Apraclonidine
*Alpha-2 and opioid receptor agonist
*α-2 and opioid receptor agonist


==Clinical Features==
==Clinical Features==
*Cardiac
*Note that initial presentation may stem from non-specific peripheral alpha1 agonism, and produce hypertension and reflex tachycardia
*Cardiac (alpha2)
**Bradycardia
**Bradycardia
**Hypotension
**Hypotension
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**Lethargy (may progress to apnea)
**Lethargy (may progress to apnea)
**Miotic pupils
**Miotic pupils
**Respiratory depression
*Respiratory
**Hypoventilation
**Hypoxia
**Cheynes-Stokes respiration
**Periodic apnea


==Differential Diagnosis==
==Differential Diagnosis==
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==Management==
==Management==
*Respiratory/neuro depression
*Respiratory/neuro depression
**Naloxone
**[[Naloxone]]
***High dose may be required (up to 10mg)
***High dose may be required (up to 10mg)
***Not always effective
***Not always effective
*Bradycardia
***May require infusion, typically 2/3 effective treatment dose per hour
**Atropine
*[[Bradycardia]]
*Hypotension
**[[Atropine]]
**IVF
*[[Hypotension]]
**[[IVF]]
 
==Disposition==


==References==
==References==

Revision as of 23:07, 22 September 2018

2D molecular structure of Clonidine

Background

  • Class: Imidazolines
  • α-2 and opioid receptor agonist

Clinical Features

  • Note that initial presentation may stem from non-specific peripheral alpha1 agonism, and produce hypertension and reflex tachycardia
  • Cardiac (alpha2)
    • Bradycardia
    • Hypotension
  • Neuro
    • Lethargy (may progress to apnea)
    • Miotic pupils
    • Respiratory depression
  • Respiratory
    • Hypoventilation
    • Hypoxia
    • Cheynes-Stokes respiration
    • Periodic apnea

Differential Diagnosis

Toxidrome Chart

Finding Cholinergic Anticholinergic Sympathomimetic Sympatholytic^ Sedative/Hypnotic
Example Organophosphates TCAs Cocaine Clonidine ETOH
Temp Nl Nl / ↑ Nl / ↑ Nl / ↓ Nl / ↓
RR Variable Nl / ↓ Variable Nl / ↓ Nl / ↓
HR Variable ↑ (sig) Nl / ↓ Nl / ↓
BP Nl / ↓ Nl / ↓
LOC Nl / Lethargic Nl, agitated, psychotic, comatose Nl, agitated, psychotic Nl, Lethargic, or Comatose Nl, Lethargic, or Comatose
Pupils Variable Mydriatic Mydriatic Nl / Miotic
Motor Fasciculations, Flacid Paralysis  Nl Nl / Agitated Nl
Skin Sweating (sig) Hot, dry Sweating Dry
Lungs Bronchospasm / rhinorrhea Nl Nl Nl
Bowel Sounds Hyperactive (SLUDGE) ↓ / Absent Nl / ↓ Nl / ↓
^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
Withdrawal from substances have the opposite effect

Evaluation

Management

Disposition

References


See Also

Toxicology (Main)