Document Type : case report
Authors
1 Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Faculty of Medicine, MTRC Mashhad University of Medical Sciences, Mashhad, Iran.
3 Professor of Pediatric Gastroenterologist, Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
4 Department of Pediatric Endocrinology and Metabolism, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract
Background: Risperidone is an atypical antipsychotic commonly prescribed for attention deficit hyperactivity disorder (ADHD) in children. An overdose can lead to significant gastrointestinal, cardiovascular, and neurological complications.
Case Presentation: We report a case of a 6-year-old boy with ADHD who inadvertently received a full tablet of risperidone every 8 hours instead of the prescribed 1/8 tablet daily. He presented to the pediatric emergency department with lethargy, shortness of breath, and chest pain after the third dose. Upon examination, he was unconscious but had stable vital signs. Initial management consisted of supportive treatment, monitoring vital signs, and fluid therapy.
Clinical Course: After 24 hours, the child regained consciousness but he developed persistent nausea and vomiting, occurring five times at half-hour intervals. Further evaluation, including an abdominal ultrasound, revealed ileocolic intussusception. The condition was successfully treated with an enema reduction, and the child was subsequently discharged in good health.
Discussion: The vomiting in this case was likely multifactorial, stemming from risperidone's side effects and the occurrence of intussusception, a rare but serious complication. This case underscores the importance of careful dosing education for caregivers and vigilance in monitoring for gastrointestinal complications in pediatric patients after medication overdose.
Conclusion: Prompt recognition and management of the complications arising from medication errors are crucial for ensuring positive outcomes in pediatric patients. Further education for parents and healthcare providers about medication dosages and potential side effects is warranted to prevent similar incidents.
Keywords
- Cheng-Shannon J, McGough JJ, Pataki C, McCracken JT. Second-generation antipsychotic medications in children and adolescents. Journal of Child & Adolescent Psychopharmacology. 2004 Sep 1;14(3):372-94.
- Pagsberg AK, Tarp S, Glintborg D, Stenstrøm AD, Fink-Jensen A, Correll CU, et al. Acute antipsychotic treatment of children and adolescents with schizophrenia-spectrum disorders: a systematic review and network meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry. 2017 Mar 1;56(3):191-202.
- Cohen D, Bonnot O, Bodeau N, Consoli A, Laurent C. Adverse effects of second-generation antipsychotics in children and adolescents: a Bayesian meta-analysis. Journal of clinical psychopharmacology. 2012 Jun 1;32(3):309-16.
- Page CB, Calver LA, Isbister GK. Risperidone overdose causes extrapyramidal effects but not cardiac toxicity. Journal of clinical psychopharmacology. 2010 Aug 1;30(4):387-90.
- Vial T, Patat AM, Paret N, Boels D, Torrents R, Nisse P, et al. Risperidone medication errors in children: an analysis of French poison centres data. Clinical Toxicology. 2019 May 4;57(5):362-7.
- Farnaghi F, Eini P, Gachkar L. Antipsychotic Drug Poisoning in Children Under 12 Years Old in Loghman-Hakim Hospital During 2016-2022. International Journal of Medical Toxicology and Forensic Medicine. 2024;14(03).
- Isbister GK, Buckley NA. The pathophysiology of serotonin toxicity in animals and humans: implications for diagnosis and treatment. Clinical neuropharmacology. 2005 Sep 1;28(5):205-14.
- Jiang J, Jiang B, Parashar U, Nguyen T, Bines J, Patel MM. Childhood intussusception: a literature review. PloS one. 2013 Jul 22;8(7):e68482.
- Applegate KE. Intussusception in children: imaging choices. InSeminars in roentgenology 2008 Jan 1 (Vol. 43, No. 1, pp. 15-21).
- Bines JE, Ivanoff B. Acute intussusception in infants and children: incidence, clinical presentation, and management: a global perspective. World Health Organization; 2002.
- Marrakchi S, Laridi A, Bouanane R, Allali N, Chat L, El Haddad S. Acute colocolic intussusception: A rare pediatric presentation. Radiology Case Reports. 2025 Jan 1;20(1):505-8.
- Battung S, Mariana N, Habar TR, Faruk M. A 5-year retrospective evaluation of invagination cases: A single-centre experience. Medicina Clínica Práctica. 2021 Apr 1;4:100233.
- Shavit I, Levy N, Dreznik Y, Soudack M, Cohen DM, Kuint RC. Practice variation in the management of pediatric intussusception: a narrative review. European Journal of Pediatrics. 2024 Nov;183(11):4897-904.
)