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Diazepam/phenobarbital Lack of efficacy: case report

A 49-year-old man exhibited a lack of efficacy with diazepam and phenobarbital while being treated for tetanus. The man was admitted to the emergency intensive care unit (EICU) with convulsions. Based on various investigations and clinical presentation, he was diagnosed with tetanus. Subsequently, he started receiving IV diazepam 10mg every 6 hours and IM phenobarbital [phenobarbitone] 100mg every 8 hours to relieve symptoms of tetanus such as convulsions and spasms. Additionally, he received tetanus immune globulin [tetanus immunoglobulin] and metronidazole concomitantly. Thirty-eight hours later, he developed trismus, generalised rigidity, and opisthotonus. These symptoms of tetanus continued for more than 10 minutes, and had not reversed by repetitive administration of phenobarbital and diazepam (lack of efficacy), which resulted in fractures of maxillary central incisors. Consequently, his heart rate reduced and blood oxygen saturation decreased. Mechanical ventilation and tracheal intubation were implemented under the sedative effect of midazolam and propofol. One week later, his symptoms relieved significantly, and he was transferred to the general ward. His condition gradually recovered in 2 weeks. Wang J, et al. Severe tetanus following ulcerated skin cancer: Case report. Medicine 99: No. 31, 31 Jul 2020. Available from: URL: http://doi.org/10.1097/ MD.0000000000021529

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Reactions 19 Sep 2020 No. 1822