Author/Authors :
Teimoory ، M نويسنده Department of Forensic Medicine and Toxicology. Tehran University of Medical Sciences, Tehran, Iran , , Arefi ، M نويسنده Department of Forensic Medicine and Toxicology. Tehran University of Medical Sciences, Tehran, Iran , , Behnoush ، B نويسنده Department of Forensic Medicine and Toxicology. Tehran University of Medical Sciences, Tehran, Iran , , Bastani ، B نويسنده Department of Forensic Medicine and Toxicology, Shahid Beheshti University of Medical Sciences, Tehran, Iran ,
Abstract :
Background:Delirium is an acute and transient turmoil disorder in consciousness which is often caused by drugs.One of the adverse effects of clonidine is agitation. Clonidine is an agonist of ?2-receptor which functionally overlaps with ?-receptor of opioids. Promethazine is H1-receptor antagonist and has antipsychotic properties. The necessary dose for initial control of agitation is 25-50 milligrams.
Case Presentation: A 27 year old man has been sent to emergency department following consumption of clonazepam 1 milligram, clonidine 0.1 milligram and alprazolam 0.5 milligram. Upon arrival at the toxicity emergency of the hospital, the patientʹs pulse rate suddenly dropped to 20 per min along with widening of QRS and increase of QTc as well as severe agitation. At the end of the second day due to continuous bradycardia pace maker was devised. The patient showed hallucination. In the third day, the patientʹs delirium increased. Due to no control of agitation by benzodiazepine, haloperidol, Promethazine 25 milligram was injected then slept after 5 minute.
Conclusion:In such patient with above restrictions, prescription of promethazine not only maintained blood pressure and caused no disorder in electrocardiogram, but also it immediately and certainly controlled patientʹs agitation.
