Q: 24 years old male recently started on an antipsychotic medicine presented to ER with choking sensation and difficulty breathing, requiring emergent intubation. Patient's friend acknowledged that patient used cocaine before taking his antipsychotic med. ED physician reports difficult intubation while advancing the Endotracheal tube. What could be the possible cause?
Answer: Antipsychotic-induced laryngospasm
A few forms of dystonia after starting antipsychotics could be life-threatening, including laryngospasm. Unfortunately, the onset is usually rapid and may involve other symptoms such as
- torticollis
- retrocollis
- oculogyric crisis, and
- opisthotonos
Young male patients with history of substance abuse, specifically cocaine, are more prone to develop laryngospasm.
This should be treated by 50 mg IV Diphenhydramine every four to six hours till the symptoms resolve. Alternatively, IV or IM 1-2 mg Benztropine can be used.
#toxicity
#pharmacology
#psychiatry
References:
1. O'Neill JR, Stephenson C. Antipsychotic-Induced Laryngeal Dystonia. Psychopharmacol Bull. 2022 Feb 25;52(1):61-67. PMID: 35342202; PMCID: PMC8896750.
2. Maguire PA, Brazel M, Looi JCL. Antipsychotic-induced acute laryngeal dystonia: A systematic review of case reports. Schizophr Res. 2024 Feb;264:248-262. doi: 10.1016/j.schres.2023.12.032. Epub 2024 Jan 6. PMID: 38185029.
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