A female presented 10 minutes ago with sudden involuntary abnormal movement in her limbs that started with inability to speak. Few hours ago, she took metoclopramide, hyoscine buty... A female presented 10 minutes ago with sudden involuntary abnormal movement in her limbs that started with inability to speak. Few hours ago, she took metoclopramide, hyoscine butylbromide, and oral rehydration solution after being diagnosed with viral gastroenteritis. The physical examination showed facial grimacing and protrusion of tongue. Which of the following is the most appropriate treatment? A. Tizanidine B. Epinephrine C. Cyproheptadine D. Diphenhydramine Read more

Understand the Problem

The question describes a patient presenting with abnormal movements and an inability to speak after taking several medications for viral gastroenteritis. The physical exam findings point towards a specific adverse drug reaction. The question asks us to identify the most likely cause from the provided options.

More Information

The patient's symptoms (sudden involuntary movements, facial grimacing, tongue protrusion, and inability to speak) after taking metoclopramide suggest an acute dystonic reaction, a type of extrapyramidal side effect of the medication. Diphenhydramine is an antihistamine with anticholinergic properties commonly used to treat acute dystonic reactions by blocking acetylcholine and restoring balance in the basal ganglia. Other options are less likely to be the first choice: Tizanidine is a muscle relaxant, Epinephrine is for anaphylaxis, and Cyproheptadine is an antihistamine with antiserotonergic effects, used for serotonin syndrome.

Tips

It is a common mistake to confuse dystonia with other movement disorders, such as tardive dyskinesia, or with other conditions causing altered mental status. Recognizing the specific features of dystonia is crucial for selecting the correct treatment.

Sources

• Tardive Dyskinesia - Symptoms and Causes - Penn Medicine - pennmedicine.org