Reactions 1680, p211 - 2 Dec 2017 Hypertension, sinus tachycardia and violent behaviour: case report A 16-year-old boy developed violent behaviour after receiving lorazepam and additionally developed sinus tachycardia and hypertension after receiving ketamine [durations of treatments to reactions onset not stated]. The boy, who had a history of seasonal allergies and recreational tobacco, marijuana abuse and alcohol use, was presented to the emergency department for erratic behaviour. On presentation, he displayed an agitated behaviour. His heart rate was 110 beats/minute and respiratory rate was 20 breaths/minute. He showed various sympathomimetic symptoms, for which he was administered 2.5 mg IV lorazepam. After receiving lorazepam, he showed a violent reaction. The boy was administered 200mg ketamine IM, after which he became passive. An electrocardiogram revealed sinus tachycardia with normal QRS and QT intervals. His BP was 150/90mm Hg. He was again administered 2.5mg IV lorazepam. He was hospitalised and further received several doses of lorazepam. On the next day, his vital signs normalised, and his symptoms returned to baseline. He reported previous use of bath salts, which subsequently lead to presence of methylenedioxypyrovalerone in his urine analysis. Author comment: "However, sedative-hypnotic agents have several disadvantages, which may limit their use when rapid containment of violent agitation is desired. . .Paradoxical excitation to benzodiazepine administration has been described." "Sympathomimetic effects including tachycardia and hypertension are thought to be secondary to inhibition of catecholamine reuptake." Kowalski JM, et al. A Novel Agent for Management of Agitated Delirium: A Case Series of Ketamine Utilization in the Pediatric Emergency Department. Pediatric Emergency Care 33: e58-e62, No. 9, Sep 2017. Available from: URL: http:// doi.org/10.1097/PEC.0000000000000578 - USA 803284118 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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