ISPUB.COM The Internet Journal of Pharmacology Volume 10 Number 1 1 of 4 Adverse Reaction To Diazepam; A Case Report B Tabowei, B Kombo, G Mukoro Citation B Tabowei, B Kombo, G Mukoro. Adverse Reaction To Diazepam; A Case Report. The Internet Journal of Pharmacology. 2012 Volume 10 Number 1. Abstract Diazepam belongs to the group known as benzodiazepines tranquilizers, anxiolytics, and anti-convulsant agent. Its use as in most drugs has been associated with side effects and adverse reactions. Although a lot of therapeutic goals can be accrued to its use, the case report would highlight an unreported adverse reaction to Diazepam. A 25 years old man had an adverse reaction to diazepam after being administered as a premedication, 10mg intravenously. The observations were tachycardia, blisters all over the body, gross swelling of the right upper limb where the drug was administered, fever, diplopia, headache, as well as sudden hypotension preceded by hypertension. He was managed adequately with steroids, antihistamine, phenergan and intravenous fluid. Notwithstanding surgery for left inguinal hernia was carried-on. INTRODUCTION Diazepam belongs to the group of drugs known as benzodiazepines. It is a tranquilizer, anxiolytic as well as anti-seizure drug 1 . They are thought to stimulate y-amino butyric acid receptors in the ascending reticular activating system and they therefore block both the cortical and limbic arousal systems following stimulation of the brain stem reticular formation. They have been shown to depress electrical discharge in septum, amygdala and hippocampus which are components of the limbic system that regulate emotion 2 . Intravenous diazepam or midazolam are used by the majority of endoscopists as premedications. In the UK, the ratio of diazepam to midazolam users is approximately 2:1 3 . CASE REPORT The reported case is about a 25 year old man, a student who was first seen in the surgical outpatient clinic two months prior to surgery with a history of swelling in the left groin of four years duration. The swelling was painful and reducible. He denied any history of trauma, fever, abdominal swelling or vomiting. He was not a known epileptic or diabetic, nor was there a history of drug allergy. He did not take alcohol or take tobacco products in any form, and was the last child in a family of four. Examination revealed a young man, not pale nor jaundiced, with a pulse rate of 76 beat per minute, regular and good volume. His blood pressure was 110/70mmHg, and the heart sounds were normal. Abdominal examination revealed a reducible left inguinal hernia. Rectal examination revealed no abnormality. A diagnosis of left reducible inguinal hernia was made. Pre- operatively, His packed cell volume was 40%, Hemoglobin concentration of 14g/dl. The white blood cell count and urinalysis done were normal. He was booked for herniorraphy. As a premedication for ketamine anesthesia, he was given intravenous diazepam 10mg slowly through infusion line. As the drug was being administered, the patient complained of severe pains on the limb and within seconds, he began to complain of tightness’ in the chest, dizziness, severe headache and double vision. He became restless and physically aggressive. On examination, he was restless, acyanossed, conscious but disoriented in time, person and place. The pulse rate was 120 beat per minutes, bounding but regular. His blood pressure was 180/110 mmHg. Heart sounds were normal. An impression of adverse reaction to diazepam was made. Intravenous hydrocortisone 200mg and intramuscular 50mg phenergan were given and then the infusion changed from normal saline to dextrose water. Thereafter patient calmed down, the pulse was still 120 beats per minute. The blood pressure dropped to 160/ 100mmHg. However, the operation was