I had a scary experience with one of my patients yesterday.
She was given a new order for Reglan 5mg via GT to try to ease her never-ending GI problems. (daily upset stomach, frequent constipation issues despite bowel meds). She is vented and on continuous tube feeding.
Anyway, she was "herself" in the morning, alert and oriented as always. I gave the first dose of Reglan around 9am. I popped in on her a few times throughout the morning. The last time I saw her alert and oriented was at 11:20am, when I went in to check on her tube feed. When I went back 20 minutes later at 11:40, to get her VS before her noon meds, she was unresponsive. (vital signs were stable). I called another nurse into the room, who also tried to get a response. She opened her eyes half-mast with a sternal rub and her pupils were the size of a pin head and barely reactive. The right side of her face looked a little droopy to me, as well. She was examined by the PA, who immediately called in the MD. All kinds of labs were ordered in the meantime. While she was being examined by the MD, about 20 minutes into this episode, she "came around" and returned to baseline. She was sent out for a CT scan which came back OK. She was placed on telemetry and oximetry and an EKG was ordered, she seems fine.
My drug book says that Reglan can cause nuero reactions (also listed--extrapyrimidal effects, lassitude, lethargy...). This patient also has 'small vessels' and there was a question as to whether she had a TIA, or maybe some kind of seizure activity. I think it's awfully cooincidental that this happened on the same day she took her first dose of Reglan. This was an unusual occurance for this patient. A nurse I work with seems to think this patient had taken this drug in the past without any problems. Has anyone else heard of a reaction like this caused by this drug? Or do you think it was more likely a TIA of some kind? (her face is fine now, no drooping.....no residual effects, mentally, either).
I was shocked and thrilled when she finally opened her eyes but I'd love to know what that was all about. I left yesterday before getting the full story and won't be back til Monday....the suspense is killing me, LOL....
Thanks so much for all of your replies, I appreciate your input. I will let you know if I hear anything this week regarding the cause of the patient's symptoms.
Have a good one!
Rachel
Hi all-
Came across this old post and realized I never filled you in......(someone asked for info if I got it). They DID chalk this patient's symptoms up to the Reglan...all other tests came back normal and I guess they must have felt it was too cooincidental that this happened after her first dose. There's been talk a couple times since then about deciding on a med to give her whenever needed, and the 'Reglan incident' is always mentioned....they steer clear of this drug with her now.
The patient is OK.....no residual effects from this incident, but it DID make me realize EVERY drug has it's potential dangers in different patients. Good lesson to learn......
i just joined and did a search for reglan iv adverse reactions. my mom was in the hospital and just came home two days ago. i stayed with her and was i ever glad i did. she had reglan iv (not sure of the dose) and went in to a deep sleep. the nac came in to get her vs and she could not be aroused. since it was shift change, the nurse also came in on the heels of the nac and began listening to her heart. he quickly began taking her pulse. he said at first it was strong, then got weak and then thready. her pupils were pin point and non-reactive. he patted her in the face, did a sternum rub and took her by the shoulders and shook her. they called for a stroke assessment and i just began yelling in her ear, "mom, can you hear me?" just as the lady from stroke assessment came in, my mom came "alive" with a long drawn out "w-h-a-t?" she was admitted because of jaundice, vomiting, headache, ache all over and they discovered in er that her heart was in a-fib. they have done all sorts of tests on her and can find nothing that would have caused this. her a-fib is a reaction to the illness which they are thinking was a virus of some type. she is 84. they did an endoscopy and the bottom of her stomach looked like someone had taken course sandpaper and rubbed it pretty well. anyway, they gave her reglan again the next day and i recognized the symptoms from the day before and called the nurse. i kept her talking, rubbing her arms and legs and after about 15 minutes she seemed better. she thanked me for waking her up because she said she felt she was slipping in to the same weird reaction she had before. after that, they gave her phenergan iv and she was okay after the first dose but the second one began to do the same thing. i'm not sure they were diluting it. i do know that reglan and phenergan must be given iv with a lot of consideration before. i think it should be given drip.
Rachel2004RN
51 Posts
Hi all-
Came across this old post and realized I never filled you in......(someone asked for info if I got it). They DID chalk this patient's symptoms up to the Reglan...all other tests came back normal and I guess they must have felt it was too cooincidental that this happened after her first dose. There's been talk a couple times since then about deciding on a med to give her whenever needed, and the 'Reglan incident' is always mentioned....they steer clear of this drug with her now.
The patient is OK.....no residual effects from this incident, but it DID make me realize EVERY drug has it's potential dangers in different patients. Good lesson to learn......