Autonomic signs

Detoxification is more successful when the patient is transitioned from a stable methadone dose with the support of ongoing therapy than when the patient comes directly from the street for detoxification from heroin. Some practitioners believe that detoxification with clonidine can be more rapid than with methadone, at least on an outpatient basis. One important hmitation of clonidine is that, although it suppresses autonomic signs of withdrawal, subject-reported symptoms, such as lethargy, restlessness, insomnia, and craving, are not well relieved (Charney et al. 1981 Jasinski et al. 1985). Anxiety may... 

Kantak, K.M., and Miczek. K.A. Social, motor, and autonomic signs of morphine withdrawal Differential sensitivities to catecholaminergie drugs in miee. Psychopharmacology 90 451-456, 1988. 

Autonomic Signs. The most common autonomic signs are profuse diaphoresis, hypersalivation, bronchorrhea, and urinary retention. Wheezing and severe bronchospasm occur occasionally. Pupils may be any size. 

Coma. Patients with PCP-induced coma are unresponsive to stimuli, are nonverbal, and have closed eyes. Some patients may have no other findings. Others may have any of the motor and autonomic signs and disturbances of vital signs listed above. A triad of coma-apnea-seizures occurs in this group. 

Any of the motor or autonomic signs, and hypertension and/or nystagmus may occur with any of the minor PCP patterns. Minor patterns should not be diagnosed on physical examination in an emergency department without adequate information about the patient s behavior and sensoriurn prior to admission. Many patients with major patterns may be alert and oriented when they reach the hospital. If no history is available, the patient is kept under observation and rhabdomyolysis is ruled out. 

Treat severe or troublesome autonomic signs and symptoms with a non-selective (3-blocker such as propranolol 20 to 40 mg four times daily. Titrate the 3-blocker dose based on signs and symptoms. 

Autonomic signs Dry mouth, blurred vision, urinary retention, constipation Muscarinic cholinoreceptor block... 

Movement disorders after withdrawal of continuous infusion, without the characteristic autonomic signs of opioid withdrawal, have been reported in children (SEDA-17,80). Fentanyl-induced seizures have been reported (10). Life-threatening complications have included raised intracranial pressure and critically reducing cerebral perfusion (11). 

Autonomic signs TBP (systolic or diastolic > 25% above baseline) BP fluctuation (change within 24h of >20mmHg diastolic or >25mmHg systolic) THR (>25% above baseline) and TRR increase (>50% above baseline) Sweating (often profuse) THR t/lBP Sweating THR T/iBP Sweating... 

Autonomic signs (e.g., salivadioiv vomiting, diaithetO and hyperthermia as Ngh as 106 F-108 F may accompany toxicolo c seizures. 

Use of die MAOIs must be discontinued 2 weeks before the administration of die SSRIs. When the SSRIs are administered witii die tricyclic antidepressants, tiiere is an increased risk of toxic effects and an increased tiierapeutic effect. When sertraline is administered witii a MAOI, a potentially fatal reaction can occur. Sjymptoms of a serious reaction include hyper-tiiermia, rigidity, autonomic instability witii fluctuating vital signs and agitation, delirium, and coma Sertraline blood levels are increased when administered witii cimetidine. 

PCP affects the sensorium, behavior, and vital signs, and it may affect motor and autonomic functions. Hypertension and nystagmus... 

Many of the signs and symptoms seem to be related to autonomic hyperactivity. As with hypothyroidism, the clinical... 

Secondary hypotension is a sign of an underlying disease that should be treated first. If stroke volume is too low, as in heart failure, a cardiac glycoside can be given to increase myocardial contractility and stroke volume. When stroke volume is decreased due to insufficient blood volume, plasma substitutes will be helpful in treating blood loss, whereas aldosterone deficiency requires administration of a mineralocor-ticoid (e.g., fludrocortisone). The latter is the drug of choice for orthostatic hypotension due to autonomic failure. A parasympatholytic (or electrical pacemaker) can restore cardiac rate in bradycardia. 

Extrapyramidal symptoms (EPS) Dystonic reactions develop primarily with the use of traditional antipsychotics. EPS has occurred during the administration of haloperidol and pimozide frequently, often during the first few days of treatment. Neuroleptic malignant syndrome (NMS) A potentially fatal symptom complex sometimes referred to as NMS has been reported in association with administration of antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, rhabdomyolysis, and acute renal failure. 

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