Vomiting diazoxide

Diazoxide Up to 24 hour <5 minute 1-3 mg/kg up to 150 mg Hypernatremia, dizziness, vomiting Avoid in patients with sulfa allergies also used in patients with hypoglycemia... 

Diazoxide is a potassium channel opener with a rapid antihypertensive action after intravenous administration. Diazoxide causes hyperglycaemia which may underlie side-effects such as nausea and vomiting, cardiac dysrhythmia and ketosis. Diazoxide was used occasionally in the management of hypertensive emergencies, but it is now largely abandoned for this indication. Diazoxide is an alternative for glucagons in patients with hypogycaemia. 

All sulfonamides, including antimicrobial sulfas, diuretics, diazoxide, and the sulfonylurea hypoglycemic agents, have been considered to be partially cross-allergenic. Flowever, evidence for this is not extensive. The most common adverse effects are fever, skin rashes, exfoliative dermatitis, photosensitivity, urticaria, nausea, vomiting, diarrhea, and difficulties referable to the urinary tract (see below). Stevens-Johnson syndrome, although relatively uncommon (ie, < 1% of treatment courses), is a particularly serious and potentially fatal type of skin and mucous membrane eruption associated with sulfonamide use. Other unwanted effects include stomatitis, conjunctivitis, arthritis, hematopoietic disturbances (see below), hepatitis, and, rarely, polyarteritis nodosa and psychosis. 

Diazoxide is a potent vasodilator chemically resembling the thiazides, but it is not a diuretic. Diazoxide can be administered both parenterally and orally. Caution has been stressed when diazoxide is administered as an intravenous bolus into the pulmonary artery because the solution is highly alkaline (pH 11.6) and irritating to vascular tissue (Cotter and Honey, 1980). In one study with chronic oral diazoxide administration (300-600 mg/day), five of seven patients had important side effects including diabetes mellitus, fluid retention, nausea, vomiting, and postural hypertension that required discontinuation of the drug (Wise, 1983). 

Three hours after receiving intravenous cisplatin 70 mg/m a patient experienced severe nausea and vomiting and his blood pressure rose from 150/90 to 248/140 mmHg. This was managed with furosemide 40 mg intravenously, hydralazine 10 mg intramuscularly, diazoxide 300 mg intravenously and propranolol 20 mg orally twice daily for 2 days. Nine days later the patient showed evidence of renal impairment (creatinine raised from about 88 micromol/L to 283 micromol/L), which resolved within 3 weeks. The patient was subsequently similarly treated on two occasions with cisplatin and again developed hypertension, but no treatment was given and there was no evidence of renal impairment. The reasons for the renal impairment are not known, but a study in rats indicate that kidney damage may possibly be related to the concentrations of cisplatin, and that furosemide can increase cisplatin levels in the kidney. However, another study in patients found that there was no difference in the toxicity or pharmacokinetics of cisplatin when furosemide was used to induce diuresis, compared with mannitol. Two other studies have also found that furosemide does not alter cisplatin pharmacokinetics. Another study showed that sodium chloride solution with or without furosemide was associated with less cisplatin nephrotoxicity than sodium chloride solution with mannitol. ... 

Another withdrawal symptom reported was that of persistent vomiting in the absence of an increase in blood pressure. Nausea and vomiting were stopped by a small dose of clonidine (97 ). Sometimes no effect is seen from clonidine administration, whilst in rare cases a paradoxical effect occurs (98). Gross overdosage was in 2 cases followed by high blood pressures, in its turn followed by hypotension, the latter apparently constituting an exaggerated response to treatment with diazepam, diazoxide and frusemide. No subsequent rebound hypertension was noted (99 ). 

Side effects which follow the intravenous injection of diazoxide also include peculiar taste sensations, nausea and vomiting after the injection, abdominal pain or low back pain and constipation. A burning sensation along the vein into which the drug is injected is often mentioned extravasation may lead to tissue necrosis and can cause extreme pain (105, 106, nos IIF). Haematological reactions include neutropenia, thrombocytopenia and eosinophilia (I05 ). Episodes of haemolysis concurrent with the use of diazoxide over several days were observed in a 26-year-old Nigerian male with severe hypertension and impaired renal function (112 ),... 

Gastrointestinal complaints, nausea and vomiting have been reported. An unusual effect seen on oral diazoxide treatment is the development of hypertrichosis, which occurs in nearly every patient after some months (105, llsCf, 116C, 117 ). The development of extrapyramidal symptoms is mentioned in one article (8 ). Despite the marked increase in serum uric acid levels during diazoxide treatment, there appears to have been no report of the precipitation of acute gout. 

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