Ergotism

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

Management

• Intake within 2 hours
  • Considered activated charcoal
  • Consider definitive airway

• Mild ergotism
  • IVF
  • Antiemetics
  • Analgesia

• Severe Peripheral Vasoconstriction or Ischemia
  • Vasodilators - nitroprusside, nitroglycerine
  • Consider corticosteroids
  • Consider heparinization

Disposition

• Consider observation for mild ergotism
• Admission for severe ergotism

See Also

• Migraine headache
• Toxicology (Main)
• Activated charcoal

References

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