II. Pharmacokinetics
- Misoprostol has rapid oral absorption
- Serum level peaks within 30 min of oral dose
- Elimination half life (including metabolites): <2 hours
- Dose dependent effects
- Mild Gastrointestinal adverse effects: 0.8 to 1.6 mg (typical dose 0.2 to 0.8 mg)
- Moderate toxicity: 3 to 8 mg
- Lethal Dose: >10 mg
III. Findings: Toxicity
- Cardiovascular
- Gastrointestinal (common even at therapeutic doses)
- Nausea or Vomiting
- Abdominal Pain or cramping
- Diarrhea
- Gynecologic
- Pelvic cramping
- Vaginal Bleeding
- Neurologic
IV. Labs
- See Unknown Ingestion for complete toxicologic lab testing
- Symptomatic patients after signifcant ingestion
- Comprehensive metabolic panel
- Creatine Phosphokinase
- Heavy Vaginal Bleeding
- Complete Blood Count
- Coagulation studies (INR, PTT)
- Pregnancy Test
- Rh Type
V. Management
- See Unknown Ingestion
-
Activated Charcoal
- Indicated if presentation in first hour of ingestion and controlled airway (e.g. patient alert)
- Supportive Care
- Intravenous Fluids
- Vasopressors (refractory Hypotension)
- Admit persistently symptomatic (e.g. Vomiting) or hemodynamically Unstable Patients
- Seizures
- Acute Renal Failure
VI. References
- Tomaszewski (2024) Crit Dec Emerg Med 38(4): 34