A girl on sulphonamides developed abdominal pain and presented to emergency with seizure. What is the probable cause?
SULFONAMIDES Sulfonamides were the first antimicrobial agents (AMAs) effective against pyogenic bacterial infections. Sulfonamido-chrysoidine (Prontosil Red) was one of the dyes included by Domagk to treat experimental streptococcal infection in mice and found it to be highly effective. Adverse effects to sulfonamides are relatively common. These are: * Nausea, vomiting and epigastric pain. * Crystalluria is dose related, but infrequent now. Precipitation in urine can be minimized by taking plenty of fluids and by alkalinizing the urine in which sulfonamides and their acetylated derivatives are more soluble. * Hypersensitivity reactions occur in 2-5deg o patients. These are mostly in the form of rashes, uicaria and drug fever. Photosensitization is repoed. Stevens-Johnson syndrome and exfoliative dermatitis are more common with long-acting agents. * Hepatitis, unrelated to dose, occurs in 0.1 o c patients. * Topical use of sulfonamides is not recommended because of risk of contact sensitization. However, ocular use is permitted. * Sulfonamides cause haemolysis in a dosedependent manner in individuals with G-6- PD deficiency. Neutropenia and other blood dyscrasias are rare. * Kernicterus may be precipitated in the newborn, especially premature, by displacement of bilirubin from plasma protein binding sites and more permeable blood-brain barrier. Most people with a deficiency of porphobilinogen deaminase never develop symptoms. In some people, however, ceain factors can precipitate symptoms, causing an attack. Factors that can cause an acute porphyria attack include Many drugs (including sex hormones, barbiturates, anticonvulsants, and sulfonamide antibiotics) Premenstrual hormonal changes in women Low-calorie, low-carbohydrate diet Ingestion of alcohol Exposure to organic solvents (for example, in dry cleaning fluids or paints). Emotional stress Infection REFERENCE: www.msdmanuals.com, essentials of medical pharmacology(k.d.tripathi,sixth edition,page no:684)
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