Metoclopramide induced pheochromocytoma crisis

Metoclopramide (MCP) is a commonly used anti-emetic in the emergency department (ED). Its use is generally well tolerated; although infrequent adverse reactions such as extrapyramidal reactions or tardive dyskinesia are reported. However, many ED providers are not familiar with the potentially life-...

Full description

Saved in:
Bibliographic Details
Published in:The American journal of emergency medicine 2018-06, Vol.36 (6), p.1124.e1-1124.e2
Main Authors: Leonard, James B., Munir, Kashif M., Kim, Hong K.
Format: Article
Language:English
Subjects:
Adrenalectomy
Adverse drug reaction
Analgesics
Blood pressure
Cardiac arrhythmia
Computed tomography
Dopamine
Drugs
Emergency medical care
Emergency medical services
Extrapyramidal system
Headache
Headaches
Hypertension
Hypertensive crisis
Intravenous administration
Liver diseases
Medical imaging
Metoclopramide
Movement disorders
Myocardial infarction
Nausea
Oxygenation
Pain
Patients
Phentolamine
Pheochromocytoma
Renal failure
Respiratory distress syndrome
Tachycardia
Tardive dyskinesia
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Metoclopramide (MCP) is a commonly used anti-emetic in the emergency department (ED). Its use is generally well tolerated; although infrequent adverse reactions such as extrapyramidal reactions or tardive dyskinesia are reported. However, many ED providers are not familiar with the potentially life-threatening hypertensive emergency that can be precipitated by MCP administration in patients with pheochromocytoma. A previously healthy 36-year-old woman presented to the ED with headache and nausea. She developed acute hypertensive emergency (acute agitation, worsening headache, chest pain and wide complex tachycardia) when her blood pressure (BP) increased to 223/102mmHg (initial BP, 134/86mmHg) after receiving intravenous MCP. Her hospital course was complicated by multi-organ injury, including acute respiratory distress syndrome requiring venous-venous extracorporeal membrane oxygenation, non-ST elevation myocardial infarction, cardiogenic shock, acute liver failure, and oliguric kidney injury requiring continuous renal replacement therapy. CT scan showed previously undiagnosed large right adrenal mass (5.9cm). The diagnosis of pheochromocytoma was confirmed after adrenalectomy. Drug-induced acute pheochromocytoma crisis is a rare event. Early recognition and appropriate blood pressure management with clevidipine, nicardipine, or phentolamine is essential.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2018.03.009