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Diverse effects of antiemetics in children
1Emergency Department, Middlemore Hospital, Auckland.
Insights
Antiemetic medications like prochlorperazine can cause dystonic reactions in children. Physicians should carefully weigh risks and benefits, especially for viral gastroenteritis, and monitor for neurological side effects.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pharmacology
- Neurology
Background:
- Antiemetics are frequently prescribed for pediatric patients, particularly for symptoms associated with viral gastroenteritis.
- Concerns exist regarding the potential for adverse neurological events associated with certain antiemetic agents in children.
Observation:
- This report details four pediatric cases presenting to an emergency department with neurological symptoms.
- Symptoms included dystonic reactions following exposure to prochlorperazine or metoclopramide, and one case of suspected phenothiazine ingestion.
Findings:
- The cases highlight a potential lack of awareness among some healthcare providers regarding the risks of antiemetics in pediatric patients.
- Acute extrapyramidal reactions, such as dystonia, are a recognized but possibly underappreciated side effect in this age group.
Implications:
- Clinicians should exercise caution when prescribing antiemetics to children, thoroughly assessing the risk-benefit ratio.
- Emphasizing potential side effects and obtaining comprehensive drug histories are crucial for prompt diagnosis and management of adverse events.
- Emergency physicians evaluating children with unusual neurological symptoms must consider antiemetic-induced extrapyramidal reactions.
Aims:
To present cases of dystonic reactions in paediatric patients related to the use of antiemetics and to remind practitioners of the potential hazards of these agents in the paediatric age group.
Method:
Discussion of the presentations of three children at the Middlemore Hospital emergency department with neurological symptoms after exposure to prochlorperazine or metoclopramide and one child with a possible phenothiazine ingestion.
Results:
These cases illustrate that some physicians are unaware of the potential hazards of antiemetics in children.
Conclusions:
Physicians prescribing antiemetics for children presenting with viral gastroenteritis should carefully consider the risks and benefits of these medications. If the drugs are prescribed, instructions about possible side effects should be emphasised so that corrective treatment can be initiated promptly. A full drug history should be obtained on all patients presenting to emergency departments. In addition, the emergency physician evaluating children with unusual neurological symptoms should always consider the possibility of an acute extrapyramidal reaction.