Reactions 1441 - 2 Mar 2013

SDiazepam

Various toxicities: case reportA 25-year-old man developed various toxicities, including

hypotension, hypertension, tachycardia, diplopia, headache,fever, blisters and swelling, following the administration ofdiazepam.

The man was scheduled for herniorraphy, and received IVdiazepam 10mg slowly through an infusion line in his rightupper limb as premedication for ketamine anaesthesia. Hereported severe limb pain as the diazepam was beingadministered, and within seconds he developed tightness inthe chest, double vision, severe headache and dizziness; hebecame physically aggressive and restless. Examinationrevealed that he was disoriented in time, person and place. Hispulse rate was 120 beats/minute and his BP was180/110mm Hg. The impression was of an adverse reaction todiazepam.

The man received hydrocortisone and promethazine, andhis infusion was switched from sodium chloride to glucose. Hesubsequently calmed down, and his BP decreased to160/100mm Hg. Herniorraphy was performed using localinfiltration with lidocaine and epinephrine [adrenaline]. In theimmediate postoperative period, his BP fell to 60/20mm Hgand his pulse rate was 130 beats/minute. He received sodiumchloride, plasma expanders, promethazine, hydrocortisoneand pentazocine. On postoperative day 1, he developed a highgrade fever and his headache continued. His right upper limbwas swollen and tender. Blisters developed all over his body.Fluid, steroid and antihistamine were continued. He wastreated for malaria, and started amoxicillin/cloxacillin andmetronidazole. On day 2, his limb oedema was subsiding, hispulse was 88 beats/minute and his BP was 120/80mm Hg. Onday 3, he had improved; his blisters were resolving, and hispulse and BP were normal and stable. He was discharged onday 7; his blisters disappeared.

Author comment: "Idiosyncrasies or peculiar mannerismis an abnormal reaction of a person to [an] otherwise normalsubstance in [an] abnormal manner. This was clearlydemonstrated in this case . . . Idiosyncratic reactions are notto be overlooked while using medications as exemplified bydiazepam."Tabowei BI, et al. Adverse reaction to diazepam; A case report. Internet Journal ofPharmacology 10: [4 pages], No. 1, 2011. Available from: URL: http://dx.doi.org/10.5580/2c92 - Nigeria 803083755

1

Reactions 2 Mar 2013 No. 14410114-9954/10/1441-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved