Case Report

Misoprostol Induced Hyperpyrexia associated with Seizures in Postpartum Parturient: Rare Side Effect and its Management in Critical Care Settings

Abstract

Misoprostol is a synthetic prostaglandin E1 analogue and has been reccommended as a safe, effective, easy to administer, cost efficient next in line drug after oxytocin, for the treatment and prevention of postpartum haemorrhage (PPH). Notwithstanding, it causes certain undesirable side effects compared to oxytocin such as nausea, vomiting, shivering, diarrhoea and transient fever. Transient pyrexia is commonly related with misoprostol administration, due to shift of hypothalamic set point. However, hyperpyrexia clubbed with seizures is a rare yet self-limiting side effect and requires prompt management strategies. There have been case reports describing fever following misoprostol administration but only few describing hyperpyrexia and even fewer describing with seizures. We report a case of hyperpyrexia associated with delayed presentation of generalised sezuires after administration of rectal misoprotol and its successful management in critical care settings.

[1] Evensen A, Anderson JM, Fontaine P. Postpartum Hemorrhage: Prevention and Treatment. Am Fam Physician. 2017; 95(7):442-49.
[2] World Health Organization. WHO recommendations Uterotonics for the prevention of postpartum haemorrhage: Web annex 7: Choice of uterotonic agents. World Health Organization; 2018.
[3] Durocher J, Bynum J, Leo´n W, Barrera G, Winikoff B. High fever following postpartum administration of sublingual misoprostol. BJOG. 2010; 117(7):845–52.
[4] Kaiser J, Royer PA. Profound hyperthermia after postpartum rectal misoprostol administration. Obstet Gynecol. 2016; 127(6):1067-9.
[5] Mohanraj P, Garg PK, Narasimalu DM. Misoprostol for termination of pregnancy-can it precipitate a seizure in a well-controlled secondary epileptic tuberculoma patient? J Turk Ger Gynecol Assoc. 2010; 11(1):65-6.
[6] Sharma N, Das R, Santa Singh Ahanthem KR. Misoprostol induced convulsion-a rare side effect of misoprostol. J Clin Diagn Res. 2017; 11(2):QD01.
[7] Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: Pharmacokinetic profiles, effects on the uterus and side effects. Int J Gynaecol Obstet. 2007; 99: S160-7.
[8] Khan RU, El-Rafaey H. Pharmacokinetics and adverse-effect profile of rectally administered misoprostol in the third stage of labor. Obstet Gynecol. 2003; 101:968–74.
[9] Von Hertzen H, Piaggio G, My Huong NT, Arustamyan K, Cabezas E, Gomez M, et al. Efficacy of two intervals and two routes of administration of misoprostol for termination of early pregnancy; a randomized controlled equivalence trial. Lancet 2007; 369: 1938-46.
[10] Medeiros F das C, Medeiros MA, Rao VS, Figueiredo EG. Effects of misoprostol in pentylenetetrazol-induced seizures in mice. Arq Neuropsiquiatr. 1997; 55(4):677-9.
Files
IssueVol 7 No 1 (2021): Winter QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/aacc.v7i1.5482
Keywords
Misoprostol Hyperpyrexia Seizures Oxytocin Postpartum Haemorrhage
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Kapoor D, Sharma M, Singh M, Sinha S, Kathuria B. Misoprostol Induced Hyperpyrexia associated with Seizures in Postpartum Parturient: Rare Side Effect and its Management in Critical Care Settings. Arch Anesth & Crit Care. 2021;7(1):50-52.