Acute Dystonic Reaction as Medical Emergency: A Report of Two Cases
A.S. is a single 28-year-old female undergraduate who presented to the medical unit with 4 days history of acute lower abdominal pains, high-grade intermittent fever, and persistent vomiting. An assessment of acute pelvic inflammatory disease was made and subsequently placed on antibiotics. However, with persistent vomiting, patient was given intramuscular metoclopramide 10 mg 8 hourly. Patient developed acute tongue twisting barely 24 h after the last injection was given and started having slurring of speech, marked protrusion of the tongue, neck stiffness, and difficulty in breathing.\nOn examination, she was in severe distress, conscious but deeply cyanosed (as evidenced by bluish coloration of the tongue) and had intermittent stiffness of the body. Vital signs were fairly stable. Intranasal oxygen was promptly administered. Cyanosis cleared within a few minutes and patient was given intramuscular biperiden lactate 1 mg stat, with resolution of spasms. Within 20 min, patient started communicating and the offending drug was discontinued.