Visceral larva migrans and Trichuris vulpis.

Abstract

Correspondence(1) In their discussion they stated, 'although it has been reported (by Casteels-Van Daele et al.) that children can have these side effects with the dose recommended by the manufacturers their patients received a dose varying between 0.56 and 1-15 mg/kg per day'.This statement was made in 1970 when we first reported on dystonic reactions caused by metoclopramide and I want to stress that at that time that was right.2Indeed, then manu- facturers recommended a dose of 0 5 to 1 mg/kg per day, but later they lowered it to 0-5 mg/kg per day.However, even on this dose dystonic reactions can occur as shown by Cases 7 and 9 in our later series of patients who received a dose of 0.52 and 0.48 mg/kg per day.3We therefore have to accept that a normal dose of metoclo- pramide can induce acute dystonic reactions.The patient should be warned in order to avoid unexplained and distressing situations later.(2) It is right that 'such reactions can be effectively stopped by administration of benztropine I mg intra- venously'.We too have used benztropine with spectacular results, all symptoms stopping almost immediately, but one ofour patients developed an atropine-like intoxication characterised by a psychotic state with extreme agitation, loquaciousness, hallucinations, motor restlessness, and bradycardia, starting 3 hours after intravenous injection and lasting for 17 hours.Children seem to be sensitive to atropine-derivatives and we suggest that 1 mg intra- venously (irrespective of age) may be too high a dose.In the younger ones (1 to 5 years old) a dose of 0. 5 mg seems to be safer.In our experience a small dose can be given by slowly injecting intravenously and stopping as soon as the dystonic reactions disappear.If the dystonic reactions are not too severe, by far the safest therapy is to stop the administration of metoclopramide immediately.