BUSPIRONE (Buspar, Neurosine)
Back to   Side-Effects

• 0.0 OVERVIEW
• 0.1 LIFE SUPPORT
• A. This overview assumes that basic life support measures have been instituted.
• 0.2 CLINICAL EFFECTS
• 0.2.1 SUMMARY OF EXPOSURE
• A. Dysphoria and CNS depression are the primary toxic manifestations, based on animal data and clinical trials.
• B. Based on the limited number of reported human overdoses, it would appear that toxicity is relatively mild, drowsiness being the most common symptom. Other potential effects may include: dizziness, loss of consciousness, gastrointestinal effects (i.e., nausea, vomiting) and small pupils.
• C. Seizures were reported in one adult 24 hours after a buspirone overdose; no other source for seizure activity was found.
• D. Buspirone appears to be less sedating than diazepam, and interacts less with ethanol.
• E. Withdrawal or rebound anxiety have not been reported with abrupt discontinuation of therapy.
• F. A related compound, ipsapirone, is currently undergoing clinical trials in the United States. Exposures should be managed as would a buspirone ingestion.
• 0.2.5 CARDIOVASCULAR
• A. Mild bradycardia and hypotension were reported in volunteers given 100 mg and has been reported in 1 case of mixed drug overdose.
• 0.2.7 NEUROLOGIC
• A. Drowsiness, fatigue, dizziness, and weakness have been reported with 10 to 20 mg doses; in overdoses of up to 300 mg, the most common effect was drowsiness (48%).
• B. Dysphoria, motor impairment, and paresthesias have been reported with buspirone use.
• C. Seizures have been reported in one adult following a buspirone-only overdose; no permanent sequelae was reported.
• D. Toxic psychosis has been reported following therapeutic use.
• 0.2.8 GASTROINTESTINAL
• A. Non-specific GI distress occurred during clinical trials including nausea, vomiting, and diarrhea.
• 0.2.10 GENITOURINARY
• A. Dysuria, enuresis, nocturia and priapism have been associated with therapeutic use.
• 0.2.18 PSYCHIATRIC
• A. Panic attacks, mania and psychosis have been reported with therapeutic use. Withdrawal is probably a rare occurrence.
• 0.2.20 REPRODUCTIVE
• A. Buspirone is FDA category B. Buspirone administration to nursing women should be avoided.
• 0.3 LABORATORY/MONITORING
• A. Serum drug levels are not clinically useful.
• B. Monitor respiration, pulse, and blood pressure in symptomatic patients.
• 0.4 TREATMENT OVERVIEW
• 0.4.2 ORAL/PARENTERAL EXPOSURE
• A. Treatment is primarily supportive and directed at CNS depression.
• B. EMESIS: Ipecac-induced emesis is not recommended because of the potential for CNS depression.
• C. GASTRIC LAVAGE: Consider after ingestion of a potentially life-threatening amount of poison if it can be performed soon after ingestion (generally within 1 hour). Protect airway by placement in Trendelenburg and left lateral decubitus position or by endotracheal intubation. Control any seizures first.
• 1. CONTRAINDICATIONS: Loss of airway protective reflexes or decreased level of consciousness in unintubated patients; following ingestion of corrosives; hydrocarbons (high aspiration potential); patients at risk of hemorrhage or gastrointestinal perforation; and trivial or non-toxic ingestion.
• D. ACTIVATED CHARCOAL: Administer charcoal as slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old.
• E. HYPOTENSION: Infuse 10 to 20 mL/kg isotonic fluid, place in Trendelenburg position. If hypotension persists, administer dopamine (5 to 20 mcg/kg/min) or norepinephrine (0.1 to 0.2 mcg/kg/min), titrate to desired response.
• F. SEIZURES: Administer a benzodiazepine IV; DIAZEPAM (ADULT: 5 to 10 mg, repeat every 10 to 15 min as needed. CHILD: 0.2 to 0.5 mg/kg, repeat every 5 min as needed) or LORAZEPAM (ADULT: 4 to 8 mg; CHILD: 0.05 to 0.1 mg/kg).
• 1. Consider phenobarbital if seizures recur after diazepam 30 mg (adults) or 10 mg (children > 5 years).
• 2. Monitor for hypotension, dysrhythmias, respiratory depression, and need for endotracheal intubation. Evaluate for hypoglycemia, electrolyte disturbances, hypoxia.
• 0.5 RANGE OF TOXICITY
• A. THERAPEUTIC DOSE is approximately 20 to 30 milligrams/day in divided doses.
• B. TOXIC serum and blood concentrations have not been established.
• C. Humans have tolerated 375 milligrams/day for 30 days but developed nausea, vomiting, tingling sensations, drowsiness, insomnia, and blurred vision.
• 1.0 SUBSTANCES INCLUDED/SYNONYMS
• 1.1 THERAPEUTIC/TOXIC CLASS
• A. Buspirone is a azaspirodecanedione derivative with anxiolytic activities in humans. It is chemically and pharmacologically unrelated to benzodiazepines, barbiturates or other sedative/anxiolytic drugs. The drug has a high affinity for serotonin (5-HT1a) receptors with no significant affinity for benzodiazepine receptors and does not affect gamma-aminobutyric acid (GABA) binding (Prod Info, 1995; USPDI, 1999).
• 1.2 SPECIFIC SUBSTANCES

o             BUSPIRONE HYDROCHLORIDE

o             MJ-9022-1

o             8-(4-(4-Pyrimidin-2-ylpiperasin-1-yl)butyl)

o               -8-asaspiro(4.5)decane-7, 9-dione hydrochloride

o             CAS 33386-08-2

• 1.6 AVAILABLE FORMS/SOURCES
• A. FORMS
• 1. Buspirone is available as 5 and 10 mg tablets, and a 15 mg multi-scored tablet which may be divided to provide doses of 5, 7.5, 10 or 15 milligrams (USPDI, 1999).
• 2. IPSAPIRONE - A related compound, ipsapirone, is currently undergoing clinical trials in the United States. Exposures should be managed as would a buspirone ingestion (Pers Comm, 1990).
• B. USES
• 1. Buspirone is used in the management of anxiety disorders, or the short-term relief of anxiety symptoms; it is NOT indicated for stress related to daily life issues (USPDI, 1999).
• 2. At the time of this review it is uncertain the role of buspirone as an adjunct therapy in the treatment of mental depression. or its possible use for the treatment of aggressive behavior in patients with neurological disorders or injury (USPDI, 1999).
• 3.0 CLINICAL EFFECTS
• 3.1 SUMMARY OF EXPOSURE
• A. Dysphoria and CNS depression are the primary toxic manifestations, based on animal data and clinical trials.
• B. Based on the limited number of reported human overdoses, it would appear that toxicity is relatively mild, drowsiness being the most common symptom. Other potential effects may include: dizziness, loss of consciousness, gastrointestinal effects (i.e., nausea, vomiting) and small pupils.
• C. Seizures were reported in one adult 24 hours after a buspirone overdose; no other source for seizure activity was found.
• D. Buspirone appears to be less sedating than diazepam, and interacts less with ethanol.
• E. Withdrawal or rebound anxiety have not been reported with abrupt discontinuation of therapy.
• F. A related compound, ipsapirone, is currently undergoing clinical trials in the United States. Exposures should be managed as would a buspirone ingestion.
• 3.4 HEENT
• 3.4.3 EYES
• A. Small pupils may be observed following overdose (USPDI, 1999).
• 3.5 CARDIOVASCULAR
• 3.5.1 SUMMARY
• A. Mild bradycardia and hypotension were reported in volunteers given 100 mg and has been reported in 1 case of mixed drug overdose.
• 3.5.2 CLINICAL EFFECTS
• A. HYPOTENSION
• 1. Volunteers given 100 mg in a single dose developed mild bradycardia and hypotension (Prod Info, 1995).
• B. BRADYCARDIA
• 1. CASE REPORT - Sustained bradycardia developed after ingestion of 200 mg buspirone, 2000 mg fluvoxamine and 300 mg flurazepam. This was almost continuously below 50 bpm and lasted 7 days after the overdose (Langlois & Paquette, 1994).
• 2. Volunteers given 100 mg in a single dose developed mild bradycardia and hypotension (Prod Info, 1995).
• 3.7 NEUROLOGIC
• 3.7.1 SUMMARY
• A. Drowsiness, fatigue, dizziness, and weakness have been reported with 10 to 20 mg doses; in overdoses of up to 300 mg, the most common effect was drowsiness (48%).
• B. Dysphoria, motor impairment, and paresthesias have been reported with buspirone use.
• C. Seizures have been reported in one adult following a buspirone-only overdose; no permanent sequelae was reported.
• D. Toxic psychosis has been reported following therapeutic use.
• 3.7.2 CLINICAL EFFECTS
• A. SEIZURES
• 1. Seizures are a possibility following overdose (Prod Info Buspar(R), 1995).
• 2. In a study using buspirone in the treatment of alcohol withdrawal syndrome, one patient with a history of alcohol-related seizures reported an unwitnessed seizure (Dougherty & Gates, 1990).
• 3. CASE REPORT - A 23-year-old female ingested 420 mg of buspirone (8.4 mg/kg) in an apparent suicide attempt, and developed generalized tonic-clonic seizures approximately 36 hours after ingestion (Catalano et al, 1998). The authors concluded that the seizure activity was probably related to buspirone toxicity, and that the delay in onset of symptoms may have been due to the protective effect of lorazepam that was given during transport. The patient made a complete recovery with no further seizure activity reported at 3-month follow-up.
• B. CNS DEPRESSION
• 1. Buspirone causes less CNS depression than the benzodiazepines and has minimal interaction with other CNS depressants (Riblet et al, 1980; USPDI, 1999).
• 2. Fatigue, drowsiness, lassitude, dizziness, and weakness have been reported with 10 to 20 mg single doses, and may be expected in overdose (Prod Info BuSpar(R), 1995; WHO, 1988; Goetz et al, 1989; USPDI, 1999).
• 3. In overdoses of up to 300 mg, the most common effect was drowsiness (48%) (Goetz et al, 1989).
• C. PARESTHESIA
• 1. Tingling in the extremities is noted with high therapeutic doses and should be expected in overdose (Prod Info, 1995; USPDI, 1999).
• D. EXTRAPYRAMIDAL DISORDER
• 1. WHO (1988) reported a few cases of extrapyramidal symptoms associated with the therapeutic use of buspirone.
• 2. CASE REPORT - Akathisia, tremors and rigidity were described in one patient receiving up to 2.4 grams/day (Sathananthan et al, 1975).
• 3. CASE REPORT - A single 5 mg dose in a 62-year-old female caused generalized myoclonus, dystonias, and akathisia within 12 hours. Diphenhydramine (25 mg IM) and benztropine (1 mg IM) had little effect on the myoclonus. The dystonias and myoclonic jerks resolved following administration of 1 mg of clonazepam (Ritchie et al, 1988).
• 4. CASE REPORTS - Authors report two cases of therapeutic buspirone induced movement disorders. These were characterized as cervical-cranial dystonia and tremors in one patient and exacerbation of a pre-existing spasmodic torticollis and tardive dyskinesia. Both patient's symptoms improved upon discontinuation of buspirone and suppressive therapy but were still present in one case 1 year later and in the other case 5 years later (LeWitt et al, 1993).
• E. PSYCHOSIS
• 1. CASE REPORTS - Two cases of buspirone-induced psychosis in children are reported (Soni & Weintraub, 1992)and one case in an HIV-infected adult (Trachman, 1992). Soni and Weintraub (1992) also note that the manufacturer has received 20 reports (ages not available) to date (1992) of psychosis induced by buspirone.
• F. DEPRESSION
• 1. Dysphoria has been reported with 40 mg doses (Kastenhoz & Crismon, 1984).
• G. ADVERSE EFFECTS
• 1. In a multicenter trial of over 6,000 patients the most common side effects included dizziness, sleeplessness, headache, uneasiness, and fatigue. All occurred with an incidence of less than 8% (Robinson et al, 1988). Observed motor skills are not affected by buspirone.
• 3.7.3 ANIMAL EFFECTS
• A. HYPOKINESIA
• 1. RATS - At doses of 2.5 mg/kg subcutaneously in rats, buspirone caused hypoactivity (Riblet et al, 1982).
• 3.8 GASTROINTESTINAL
• 3.8.1 SUMMARY
• A. Non-specific GI distress occurred during clinical trials including nausea, vomiting, and diarrhea.
• 3.8.2 CLINICAL EFFECTS
• A. DYSPEPSIA
• 1. Non-specific GI distress occurred during clinical trials (Robinson et al, 1988).
• 2. Nausea, vomiting, and diarrhea were reported following therapeutic use and in overdose (Prod Info Buspar(R), 1995; USPDI, 1999).
• 3.10 GENITOURINARY
• 3.10.1 SUMMARY
• A. Dysuria, enuresis, nocturia and priapism have been associated with therapeutic use.
• 3.10.2 CLINICAL EFFECTS
• A. MICTURITION FREQUENCY
• 1. Dysuria, enuresis, and nocturia have been associated with the therapeutic use of buspirone (Coates, 1990).
• B. PRIAPISM
• 1. CASE REPORT - Priapism and acute urinary retention was reported in a mentally retarded man after receiving buspirone 15 to 30 mg/day for 6 months (Coates, 1990).
• 3.18 PSYCHIATRIC
• 3.18.1 SUMMARY
• A. Panic attacks, mania and psychosis have been reported with therapeutic use. Withdrawal is probably a rare occurrence.
• 3.18.2 CLINICAL EFFECTS
• A. AGITATION
• 1. CASE REPORT - An acute panic attack with hypertension was reported on 2 occasions in a patient with a history of panic disorder following 10 mg doses. The authors speculated that the 1-(2-pyrimidinyl)piperazine metabolite of buspirone may have some anxiogenic and hypertensive effects (Chignon & Lepine, 1989). The relationship between the metabolite and panic attacks is unclear at best (Fuller, 1990; Pols et al, 1989).
• B. MANIC REACTION
• 1. Mania with flight of ideas, pressured speech, and elated mood have been reported with the therapeutic use of buspirone (McIvor & Sinanan, 1991). In this case the patient was also taking disulfiram 400mg/day which may be a contributing factor (Iruela et al, 1991).
• 3.20 REPRODUCTIVE
• 3.20.1 SUMMARY
• A. Buspirone is FDA category B. Buspirone administration to nursing women should be avoided.
• 3.20.2 TERATOGENICITY
• A. LACK OF EFFECT
• 1. Reproduction studies performed in rats and rabbits found no fetal damage or fertility impairment when buspirone was administered in doses of approximately 30 times the maximum recommended human dose (BuSpar(R) Prod Info, 1995).
• 3.20.3 EFFECTS IN PREGNANCY
• A. PREGNANCY CATEGORY
• 1. FDA Pregnancy Category B: There are insufficient data available in humans. Buspirone should be used during pregnancy only if clearly needed (BuSpar(R) Prod Info, 1995; USPDI, 1999).
• 3.20.4 EFFECTS DURING BREAST-FEEDING
• A. BREAST MILK
• 1. There are insufficient data available in humans to determine the extent of the excretion of buspirone in breast milk (BuSpar(R) Prod Info, 1995; USPDI, 1999).
• 2. Buspirone administration to nursing women should be avoided (Prod Info BuSpar(R), 1995). At the time of this review, problems with breast feeding have not been reported (USPDI, 1999).
• 3.21 CARCINOGENICITY
• 3.21.4 ANIMAL STUDIES
• A. LACK OF EFFECT
• 1. RATS - A 24-month study in rats using doses 133 times the recommended maximum human oral dose and an 18-month study in mice using 167 times the recommended maximum human oral dose found no evidence of carcinogenic potential (BuSpar(R) Prod Info, 1995).
• 3.22 GENOTOXICITY
• A. MUTAGENICITY - Buspirone did not induce point mutations, with or without metabolic activation, in 5 strains of Salmonella typhimurium (Ames Test) or mouse lymphoma L5178YTK+ (BuSpar(R) Prod Info, 1995).
• B. CHROMOSOME ABERRATIONS - Mice given one or five daily doses of buspirone had no chromosomal aberrations or abnormalities in bone marrow cells (BuSpar(R) Prod Info, 1995; USPDI, 1999).
• 3.23 OTHER
• 3.23.2 CLINICAL EFFECTS
• A. WITHDRAWAL SYNDROME
• 1. In a review article, the author states that the long term use of buspirone is unlikely to cause abuse dependence or withdrawal. The manufacturer, as of 1989, has received only a few unsubstantiated reports of withdrawal symptoms (irritability, headache, blurred vision, and shakiness) (Lader, 1991).
• 2. At the time of this review, buspirone appears to lack the potential for physical dependence; withdrawal symptoms or rebound anxiety have not been reported with abrupt discontinuation of therapy (USPDI, 1999).
• B. OTHER
• 1. A related compound, ipsapirone, is currently undergoing clinical trials in the United States. Exposures should be managed as would a buspirone ingestion (Pers Comm, 1990).
• C. DRUG INTERACTION
• 1. Peak plasma concentrations were increased 5-fold and 13-fold, respectively following the co-administration of erythromycin or itraconazole (Baselt, 2000).
• 4.0 LABORATORY/MONITORING
• 4.1 MONITORING PARAMETERS/LEVELS
• 4.1.1 SUMMARY
• A. Serum drug levels are not clinically useful.
• B. Monitor respiration, pulse, and blood pressure in symptomatic patients.
• 4.1.2 SERUM/BLOOD
• A. BLOOD/SERUM CHEMISTRY
• 1. Serum drug levels are not clinically useful.
• 4.1.4 OTHER
• A. MONITORING
• 1. Monitor ECG for possible bradycardia.
• 2. Blood pressure should be monitored for possible hypotension.
• 4.3 METHODS
• A. CHROMATOGRAPHY
• 1. Liquid chromatography or gas chromatography-mass spectrometry have been used to determine buspirone in biological specimens (reviewed in Baselt, 2000).
• B. RADIOIMMUNOASSAY
• 1. A radioimmunoassay has been described as being adequately sensitive to analyze buspirone plasma concentrations following a single therapeutic dose (reviewed in Baselt, 2000).
• 5.0 ABSTRACTS
• 5.1 CASE REPORTS
• A. ADVERSE EFFECTS
• 1. In one study buspirone was administered to 118 patients for the treatment of alcohol withdrawal syndrome. Patients received 5 mg to greater than 110 mg daily of buspirone. One patient with a history of alcohol-related seizures reported an unwitnessed seizure. None of the other patients experienced side effects attributed to buspirone (Dougherty & Gates, 1990).
• 2. A 25-year-old man ingested 250 mg of buspirone along with at least 25 mg of diazepam. The patient was assessed shortly after the overdose and no adverse effects were noted (Tiller et al, 1989).
• 3. A case of intentional ingestion of 200 mg buspirone, 2000 mg fluvoxamine and 300 mg flurazepam is reported. The patient described intense dizziness, vomiting and diarrhea. Sinus bradycardia (50 bpm) was continuously sustained for 7 1/2 days but blood pressure was maintained at acceptable levels (Langlois & Paquette, 1994).
• 5.2 CASE SERIES
• A. ADVERSE EFFECTS
• 1. In a six-month prospective study of 25 patients who ingested buspirone alone and with co-ingestants, toxicity was found to be relatively mild. The amount of buspirone ingested ranged from 5 mg to 300 mg.
• a. Side effects ranging from none to mild were reported in 88% of the patients, moderate effects in 8%, and 1 death. Drowsiness was the most common symptom, occurring in 48% of the patients.
• b. Gastric decontamination was the only treatment necessary in 92% of the cases. Based on this preliminary study, it appears that buspirone overdose usually results in rather benign symptomatology (Goetz et al, 1989).
• 6.0 TREATMENT
• 6.1 LIFE SUPPORT
• A. Support respiratory and cardiovascular function.
• 6.4 MONITORING
• A. Serum drug levels are not clinically useful.
• B. Monitor respiration, pulse, and blood pressure in symptomatic patients.
• 6.5 ORAL EXPOSURE
• 6.5.1 PREVENTION OF ABSORPTION/PREHOSPITAL
• A. EMESIS/NOT RECOMMENDED -
• 1. EMESIS: Ipecac-induced emesis is not recommended because of the potential for CNS depression.
• B. ACTIVATED CHARCOAL -
• 1. PREHOSPITAL ACTIVATED CHARCOAL ADMINISTRATION
• a. Consider prehospital administration of activated charcoal as an aqueous slurry in patients with a potentially toxic ingestion who are awake and able to protect their airway. Activated charcoal is most effective when administered within one hour of ingestion.
• (1) In patients who are at risk for the abrupt onset of seizures or mental status depression, activated charcoal should be administered by medical or paramedical personnel capable of airway management to prevent aspiration in the event of spontaneous emesis.
• 2. CHARCOAL DOSE
• a. Use a minimum of 240 milliliters of water per 30 grams charcoal (FDA, 1985). Optimum dose not established; usual dose is 25 to 100 grams in adults and adolescents; 25 to 50 grams in children aged 1 to 12 years; and 1 gram/kilogram in infants up to 1 year old (USP DI, 2000; Chyka & Seger, 1997).
• (1) Routine use of a cathartic with activated charcoal is NOT recommended as there is no evidence that cathartics reduce drug absorption and cathartics are known to cause adverse effects such as nausea, vomiting, abdominal cramps, electrolyte imbalances and occasionally hypotension (Barceloux et al, 1997).
• b. ADVERSE EFFECTS/CONTRAINDICATIONS
• (1) Complications: emesis, aspiration (Chyka & Seger, 1997). Refer to the ACTIVATED CHARCOAL/TREATMENT management for further information.
• (2) Contraindications: unprotected airway, gastrointestinal tract not anatomically intact, therapy may increase the risk or severity of aspiration; ingestion of most hydrocarbons (Chyka & Seger, 1997).
• 6.5.2 PREVENTION OF ABSORPTION
• A. ACTIVATED CHARCOAL
• 1. CHARCOAL ADMINISTRATION
• a. Consider administration of activated charcoal after a potentially toxic ingestion (Chyka & Seger, 1997). Administer charcoal as an aqueous slurry; most effective when administered within one hour of ingestion.
• 2. CHARCOAL DOSE
• a. Use a minimum of 240 milliliters of water per 30 grams charcoal (FDA, 1985). Optimum dose not established; usual dose is 25 to 100 grams in adults and adolescents; 25 to 50 grams in children aged 1 to 12 years; and 1 gram/kilogram in infants up to 1 year old (USP DI, 2000; Chyka & Seger, 1997).
• (1) Routine use of a cathartic with activated charcoal is NOT recommended as there is no evidence that cathartics reduce drug absorption and cathartics are known to cause adverse effects such as nausea, vomiting, abdominal cramps, electrolyte imbalances and occasionally hypotension (Barceloux et al, 1997).
• b. ADVERSE EFFECTS/CONTRAINDICATIONS
• (1) Complications: emesis, aspiration (Chyka & Seger, 1997). Refer to the ACTIVATED CHARCOAL/TREATMENT management for further information.
• (2) Contraindications: unprotected airway, gastrointestinal tract not anatomically intact, therapy may increase the risk or severity of aspiration; ingestion of most hydrocarbons (Chyka & Seger, 1997).
• B. GASTRIC LAVAGE
• 1. INDICATIONS: Consider gastric lavage with a large-bore orogastric tube (ADULT: 36 to 40 French or 30 English gauge tube {external diameter 12 to 13.3 mm}; CHILD: 24 to 28 French {diameter 7.8 to 9.3 mm}) after a potentially life threatening ingestion if it can be performed soon after ingestion (generally within 60 minutes).
• a. Consider lavage more than 60 minutes after ingestion of sustained-release formulations and substances known to form bezoars or concretions.
• 2. PRECAUTIONS:
• a. SEIZURE CONTROL: Is mandatory prior to gastric lavage.
• b. AIRWAY PROTECTION: Alert patients - place in Trendelenburg and left lateral decubitus position, with suction available. Obtunded or unconscious patients - cuffed endotracheal intubation.
• 3. LAVAGE FLUID:
• a. Use small aliquots of liquid. Lavage with 150 to 200 milliliters warm tap water (preferably 38 degrees Celsius) or saline per wash (in children over 5 or adults) and 10 milliliters/kilogram body weight of normal saline in young children. Continue until lavage return is clear.
• b. The volume of lavage return should approximate amount of fluid given to avoid fluid-electrolyte imbalance.
• c. CAUTION: Water should be avoided in young children because of the risk of electrolyte imbalance and water intoxication. Warm fluids avoid the risk of hypothermia in very young children and the elderly.
• 4. COMPLICATIONS:
• a. Complications of gastric lavage have included: aspiration pneumonia, hypoxia, hypercapnia, mechanical injury to the throat, esophagus, or stomach, fluid and electrolyte imbalance (Vale, 1997). Combative patients may be at greater risk for complications.
• b. Gastric lavage can cause significant morbidity; it should NOT be performed routinely in all poisoned patients (Vale, 1997).
• 5. CONTRAINDICATIONS:
• a. Loss of airway protective reflexes or decreased level of consciousness if patient is not intubated, following ingestion of corrosive substances, hydrocarbons (high aspiration potential), patients at risk of hemorrhage or gastrointestinal perforation, or trivial or non-toxic ingestion.
• 6.5.3 TREATMENT
• A. MONITORING PARAMETERS
• 1. Monitor respiration, pulse, and blood pressure.
• 2. Monitor hepatic function following a significant exposure or in patients with known hepatic dysfunction.
• B. HYPOTENSION
• 1. SUMMARY
• a. Infuse 10 to 20 milliliters/kilogram of isotonic fluid and place in Trendelenburg position. If hypotension persists, administer dopamine or norepinephrine. Consider central venous pressure monitoring to guide further fluid therapy.
• 2. DOPAMINE
• a. PREPARATION: Add 200 or 400 milligrams to 250 milliliters of normal saline or dextrose 5% in water to produce 800 or 1600 micrograms per milliliter or add 400 milligrams to 500 milliliters of normal saline or dextrose 5% in water to produce 800 micrograms per milliliter.