Case report of metoclopramide induced dystonia in primary health care in Jazan, Saudi Arabia, 2022

Metoclopramide hydrochloride, a neuroleptic dopamine receptor antagonist used to treat gastric ailments, is reported to cause extrapyramidal movement disorder. Our case in rural district in Jazan, Southern area in Saudi Arabia the medical service provided by general practitioner, deal with simple cases only and refer the complicated one. A 44 years old Saudi male, came to primary health care center complain of epigastric pain after eating spicy meal he has epigastric pain localize not radiating and vomiting of whatever he drinks or eat he was assessed by general practitioner and diagnosed as acute gastritis, 10 mg metoclopramide, After he received the injection; the patient developed a spasticity and rigors over all his limps, difficulty of speaking and a noisy breathing was heard but not strider, his tongue was contracted and retracted. He remained fully conscious during this episode. The patient connected to monitor, Oxygen mask, and placed on lateral position, His SPO2 dropped to 81%, Metoclopramide was discontinued, A Promethazine was given, diagnosed as adverse effect of metoclopramide, After 10 minutes the breathing return to normal and SPO2 98% maintained in room air while the spasticity of the limps stopped after 2 hours.no further dystonic reaction were observed. Conclusion: Metoclopramide has rare adverse effects, but itsquite serious central nervus system disorders: Tardive dyskinesia, acute dystonic reactions, drug-induced parkinsonism, akathisia, other extrapyramidal symptoms, convulsive seizure, hallucinations, neuroleptic which need to be treated with well-trained health care providers and well equipped health facilities.