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Diagnosis: A 2 month Old with "Seizures"

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At the ER he was given Oxygen and intravenous diazepam which reduces his heart rate, rigidity. He because more responsive after the second intravenous diazepam.

This baby was initially thought to have seizures, however, EEG (brain wave), CT of the head, spinal tap, and other blood tests were all normal. A neurologist was consulted and diagnosed the baby with “dystonic reaction” as an adverse reaction from the metoclopromide.

Metoclopromide was stopped and anti-reflux measures were recommended. The baby improved.

“Dystonic reaction,” technically called extrapyramidal reactions to drugs occurs in about 10% of young children and seniors who are on metoclopromide. These side effects usually occur within a few days after starting the medication. It occurs more commonly when higher dose is given. The “dystonic reaction” is short lived after the medication is stopped. In some cases it could occur after the first dose.

The treatment for “dystonic reaction” is intravenous or intramuscular injection of diphenhydramine (Benadryl) or benztropine mesylate. In children, diphenhydramine is usually used.

[Comment: I have avoided the use of metoclopromide for several years now exactly because of “dystonic reaction” plus my belief that most of the so called “reflux” in infants is from allergy to cow’s or soy milk. I rarely use medications for “acid reflux” during infancy unless there is poor weight gain, persistent severe “belly pain,” frequent respiratory problem, and other breathing problems. In our office, we use the following formulas in the management of “reflux” in infancy: Enfamil AR, Nutramigen, Alimentum, and Neo-cate.]

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