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Clonidine toxicity
From WikEM
Contents
Background
- Class: Imidazolines
- Clonidine
- Guanfacine
- Oxymetazoline(Afrin)
- Tetrahydrolozine (Visine)
- Naphazoline (Naphcon)
- Apraclonidine
- Alpha-2 and opioid receptor agonist
Clinical Features
- Cardiac
- Bradycardia
- Hypotension
- Neuro
- Lethargy (may progress to apnea)
- Miotic pupils
- Respiratory depression
Differential Diagnosis
Toxidrome Chart
| Finding | Cholinergic | Anticholinergic | Sympathomimetic | Sympatholytic^ | Sedative/Hypnotic |
| Example | Organophosphates | TCAs | Cocaine | Clonidine | ETOH |
| Temp | Nl | Nl / ↑ | Nl / ↑ | Nl / ↓ | Nl / ↓ |
| RR | Variable | Nl / ↓ | Variable | Nl / ↓ | Nl / ↓ |
| HR | Variable | ↑ | ↑ (sig) | Nl / ↓ | Nl / ↓ |
| BP | ↑ | ↑ | ↑ | Nl / ↓ | Nl / ↓ |
| LOC | Nl / Lethargic | Nl, agitated, psychotic, comatose | Nl, agitated, psychotic | Nl, Lethargic, or Comatose | Nl, Lethargic, or Comatose |
| Pupils | Varriable | Mydriatic | Mydriatic | Nl / Miotic | |
| Motor | Fasciculations, Flacid Paralysis | Nl | Nl / Agitated | Nl | |
| Skin | Sweating (sig) | Hot, dry | Sweating | Dry | |
| Lungs | Bronchospasm / rhinorrhea | Nl | Nl | Nl | |
| Bowel Sounds | Hyperactive (SLUDGE) | ↓ / Absent | Nl / ↓ | Nl / ↓ |
- ^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
- Withdrawal from substances have the opposite effect
Evaluation
Management
- Respiratory/neuro depression
- Naloxone
- High dose may be required (up to 10mg)
- Not always effective
- Naloxone
- Bradycardia
- Hypotension
Disposition
References
