Pediatric Emergency Service Admissions due to Acute Dystonic Reaction Induced by Metoclopramide

Abstract

Objective: Metoclopramide is a dopamine receptor antagonist. It is not routinely recommended in children, particularly because of its extrapyramidal side effects. In this study, it was aimed to examine the reasons for the use of metoclopramide and their response to emergency treatment in children who developed acute extrapyramidal symptoms due to metoclopramide use. Methods: Patients who applied to the pediatric emergency service between 01.06.2019 and 31.05.2020 because of side effects related to the use of metoclopramide were included in the study. All the patients were treated with biperidene lactate. Results: Twenty patients without chronic disease, who were not taking any medication other than metoclopramide, and had an acute dystonic reaction due to metoclopramide for the first time were evaluated (median: 33.5 months, 55% male). Seventeen of the patients had taken the medication for acute gastroenteritis, two for motion sickness and one for a suicide attempt. In 16 patients, the drug was given by their mothers without a doctor's recommendation. Side effects in the normal dose range occurred in 16 of the patients. Findings occurred within a median of 4 h after metoclopramide ingestion. The median response to biperiden lactate treatment was 15 min. A positive and significant correlation was found between the metoclopramide dose taken and the clinical response time to biperiden lactate administered in the emergency department (r: 0.514; p=0.018). Conclusion: Metoclopramide causes an acute dystonic reaction in children, even in the normal dose range. Biperiden lactate is an effective and rapid treatment option. As the metoclopramide dose increases, clinical improvement occurs later.

Keywords

• acute dystonic reaction
• metoclopramide
• biperiden lactate