Case of acute akathisia from intravenous metoclopramide

Intravenous (IV) metoclopramide is a frequently prescribed medication in the emergency department (ED). Extrapyramidal side effects like tardive dyskinesia are known to develop with chronic use of metoclopramide, while acute akathisia is a lesser known side effect following IV administration. Akathisia is characterised by a sensation of restlessness and distress, as well as constant, non-purposeful limb movement. It can present as a diagnostic challenge, cause distress and hinder the management of the primary condition of the patient in the ED. However, akathisia can be readily reversible, with a successful patient outcome if promptly diagnosed. We report a case of acute akathisia in a young female patient after IV bolus metoclopramide was administered to treat her gastroenteritis in our ED. We highlight the diagnostic process, the difficulties in the management of the primary condition resulting from her akathisia and its successful management using IV diphenhydramine and midazolam.