SAQ 184 – Toxicology and Elder Care – promethazine toxicity and neglect

Question 9. promethazine toxicity and neglect.

a. Promethazine toxicity features

• Drowsiness, coma, visual hallucinations, behavioural disturbance, slurred speech, or seizures.
• Tremor or myoclonus.
• Mydriasis.
• Tachycardia or hypertension.
• Hyperthermia.
• Dry flushed skin or dry mouth.
• Ileus or urinary retention.

b. Other anticholinergic causes

• Tricyclic antidepressant.
• Antipsychotic such as haloperidol or chlorpromazine.
• Anticonvulsant such as carbamazepine.
• Antihypertensive such as propranolol.
• Antiparkinsonian drug such as benztropine.
• Antimuscarinic agent such as atropine.
• Datura or anticholinergic mushrooms.

c. Decontamination

• There is generally no role for decontamination.
• Activated charcoal is not indicated because early drowsiness creates an aspiration risk.

d. Enhanced elimination

• Enhanced elimination is not clinically useful.

e. Antidote

• Physostigmine may be considered for severe anticholinergic delirium not controlled with benzodiazepines.

f. Elder neglect features

• Malnutrition.
• Poor hygiene.
• Pressure injuries.
• Bruises or unexplained injuries.
• Inappropriate or antagonistic family interactions.
• Inadequate clothing, medication access, or untreated disease.