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Misoprostol Poisoning

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Misoprostol Poisoning, Misoprostol Overdose, Misoprostol Toxicity

  • See Also
  1. Misoprostol
  2. Unknown Ingestion
  • Pharmacokinetics
  1. Misoprostol has rapid oral absorption
  2. Serum level peaks within 30 min of oral dose
  3. Elimination half life (including metabolites): <2 hours
  4. Dose dependent effects
    1. Mild Gastrointestinal adverse effects: 0.8 to 1.6 mg (typical dose 0.2 to 0.8 mg)
    2. Moderate toxicity: 3 to 8 mg
    3. Lethal Dose: >10 mg
  • Findings
  • Toxicity
  1. Cardiovascular
    1. Tachycardia
    2. Hypotension
  2. Gastrointestinal (common even at therapeutic doses)
    1. Nausea or Vomiting
    2. Abdominal Pain or cramping
    3. Diarrhea
  3. Gynecologic
    1. Pelvic cramping
    2. Vaginal Bleeding
  4. Neurologic
    1. Headache
    2. Sedation
    3. Tremor
    4. Seizure
  • Labs
  1. See Unknown Ingestion for complete toxicologic lab testing
  2. Symptomatic patients after signifcant ingestion
    1. Comprehensive metabolic panel
      1. Metabolic Acidosis with Anion Gap
      2. Acute Kidney Injury
      3. Elevated Liver Function Tests
    2. Creatine Phosphokinase
      1. Rhabdomyolysis
  3. Heavy Vaginal Bleeding
    1. Complete Blood Count
    2. Coagulation studies (INR, PTT)
    3. Pregnancy Test
    4. Rh Type
  • Management
  1. See Unknown Ingestion
  2. Activated Charcoal
    1. Indicated if presentation in first hour of ingestion and controlled airway (e.g. patient alert)
  3. Supportive Care
    1. Intravenous Fluids
    2. Vasopressors (refractory Hypotension)
    3. Admit persistently symptomatic (e.g. Vomiting) or hemodynamically Unstable Patients
  4. Seizures
    1. Benzodiazepines
  5. Acute Renal Failure
    1. Hemodialysis
  • References
  1. Tomaszewski (2024) Crit Dec Emerg Med 38(4): 34