Late onset dystonia following risperidone overdose [Abstract]

Dyas, J., King, R., Veiraiah, A. and Thompson, John Paul 2010. Late onset dystonia following risperidone overdose [Abstract]. Clinical Toxicology 48 (3) , pp. 260-261. 10.3109/15563651003740240

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Abstract

Objective: Risperidone overdose is generally associated with mild and predictable clinical effects, including sedation, tachycardia and dystonia, which are usually resolved within 24 hours of ingestion. We report the management of a case of risperidone overdose in a 28 year old woman who remained asymptomatic for almost 60 hours post-ingestion before the sudden onset of an acute dystonic reaction of the tongue and throat.  Case report: The patient presented following the sudden onset of extremely distressing spasm and swelling of her tongue, neck and side of face, two and a half days after an alleged overdose with 90 mg of a friend's risperidone. She was dyspnoeic and could not speak. Examination was unremarkable except for an acute dystonia of her tongue and throat, noisy breathing without true stridor, and sinus tachycardia (HR 150). Neurological examination was normal except for the dystonia. Coagulation, renal and liver function test results were within normal limits. Procyclidine was given as an intravenous bolus of 10 mg. The patient described a reduction in the swelling and spasm of her tongue and throat within 30 minutes of treatment. Serum risperidone concentration at the time of presentation was below the limit of detection for the assay and the concentration of the active metabolite, 9-OH risperidone, was 31 μg/L, which is within the normal range of 10 - 90 μg/L for patients taking risperidone therapeutically. Her heart rate settled following resolution of the dystonia and she was discharged the same day.  Conclusion:  This case report confirms that dystonic reactions can occur some days after an otherwise asymptomatic overdose of risperidone, even in the absence of elevated blood concentrations of the parent drug or its metabolite. Although dystonic reactions are not usually life-threatening, the localisation in this case of the dystonia in the mouth and throat led to severe distress that was treated effectively with procyclidine.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Subjects:	R Medicine > R Medicine (General)
Additional Information:	2010 International Congress of the European Association of Poisons Centres and Clinical Toxicologists, 11-14 May 2010, Bordeaux, France
Publisher:	Informa Healthcare
ISSN:	0731-3810
Last Modified:	22 Feb 2013 03:25
URI:	https://orca.cardiff.ac.uk/id/eprint/18496

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