Gray syndrome

Children Use with caution and in reduced dosages in premature and full-term infants to avoid gray syndrome toxicity. Monitor drug serum levels carefully during therapy of the newborn. 

Toxic reactions including fatalities (approximately 40%) have occurred in the premature infant and newborn the signs and symptoms associated with these reactions have been referred to as the gray syndrome. ... 

Rogers KC, Wolfe DA. Amiodarone-induced blue-gray syndrome. Ann Pharmacother 2000 34(9) 1075. 

The gray syndrome is the term given to the vasomotor collapse that occurs in neonates who are given excessive parenteral doses of chloramphenicol. The syndrome is characterized by an ashen gray, cyanotic color of the skin, a fall in body temperature, vomiting, a protuberant abdomen, refusal to suck, irregular and rapid respiration. 

Chloramphenicol penetrates the fetal circulation and should therefore be avoided during the last phase of pregnancy (62,63). The gray syndrome has been observed in babies born to mothers who had received chloramphenicol in the final stage of pregnancy. 

The most important adverse effects are an immediate dose-related and reversible disturbance of erythropoiesis (2,3) and peripheral neuropathy. In contrast to chloramphenicol, aplastic anemia and the gray syndrome do not seem to occur with thiamphenicol. 

Not for use in patients who are pregnant or are breastfeeding. Neonates may develop gray syndrome (blue-gray skin, hypothermia, irregular breathing, coma, and cardiovascular collapse). 

Note Gray syndrome toxic reactions in premature infants and newborns. Signs and symptoms include abdominal distension, blue-gray skin color, low body temperature, and uneven breathing... 

Pandhi RK+, Australasian J Dermatol 26, 88 Gray syndrome Hypersensitivity Jarisch-Herxheimer reaction (1983) Perine PL+, Am J Trop Med Hyg 32(5), 1096... 

Reversible or irreversible bone marrow depression, leukopenia, aplastic anemia (1 40,000 cases). Must follow blood counts during therapy. Gray syndrome (See Notes column). 

Patients who take chloramphenicol may also experience rash, fever, and dyspnea. Neonates experience gray syndrome. 

Ohta T, Gray TA, Rogan PK et al. Imprinting-mutation mechanisms in Prader-Willi syndrome. Am ) Hum Genet 1999 64[2] 397-413. 

Chlor am phe ni co 1 Gray baby syndrome, aplastic anemia... 

The answer is c. (Hardman, pp 1134-1135.) Hematologic toxicity is by far the most important adverse effect of chloramphenicol The toxicity consists of two types (1) bone marrow depression (common) and (2) aplastic anemia (rare) Chloramphenicol can produce a potentially fatal toxic reaction, the gray baby syndrome, caused by diminished ability of neonates to conjugate chloramphenicol with resultant high serum concentrations. Tetracyclines produce staining of the teeth and phototoxicity... 

Gray platelet syndrome Lack of alpha granules... 

Mori, K., Suztrki, S., and Sugai, K., Electron microscopic and functional smdies on platelets in gray platelet syndrome. Tohoku J. Exp. Med. 143, 261-287 (1984). 

Levy-Toledanos, S., Caen, J. R, Breton-Gorius, J., etal, Gray platelet syndrome Alpha-granule deficiency Its influence on platelet function. J. Lab. Clin. Med. 98, 831-848 (1981). 

Lages, B., Sussman, I. I., Levine, P. S., et al., Platelet alpha granule deficiency associated with decreased P-Selectin and selective impairment of thrombin-induced activation in a new patient with gray platelet syndrome (alpha-storage pool deficiency). J. Lab. Clin. Med. 129, 364-375 (1997). 

The gray-baby syndrome occurs in babies which are still deficient in glucuronyl-transferase. The syndrome is characterized by distension of the abdomen, anorexia, progressive cyanosis, vasomotor collapse, hypothermia and shock. 

---