Clonidine toxicity: Difference between revisions
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**Naphazoline (Naphcon) | **Naphazoline (Naphcon) | ||
**Apraclonidine | **Apraclonidine | ||
* | *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
Background
- Class: Imidazolines
- Clonidine
- Guanfacine
- Oxymetazoline(Afrin)
- Tetrahydrolozine (Visine)
- Naphazoline (Naphcon)
- Apraclonidine
- 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
- Respiratory/neuro depression
- Naloxone
- High dose may be required (up to 10mg)
- Not always effective
- May require infusion, typically 2/3 effective treatment dose per hour
- Naloxone
- Bradycardia
- Hypotension
Disposition
References