Grey syndrome

Grey syndrome is a rare, severe adverse reaction to the antibiotic chloramphenicol, primarily seen in neonates and infants. The syndrome is characterized by a triad of symptoms: cyanosis, hypothermia, and cardiovascular collapse.

Etiology

Grey syndrome is caused by the accumulation of chloramphenicol in the body, which can occur due to a variety of reasons. The most common cause is the administration of high doses of the drug, especially in neonates and infants who have immature liver function and are unable to metabolize and excrete the drug efficiently. Other factors that can contribute to the development of Grey syndrome include premature birth, kidney disease, and concurrent use of other medications that inhibit the metabolism of chloramphenicol.

Symptoms

The symptoms of Grey syndrome typically appear within 2 to 9 days after the start of chloramphenicol treatment. The most characteristic symptom is a progressive, ashen-gray discoloration of the skin, which gives the syndrome its name. Other symptoms include:

• Cyanosis, or a bluish discoloration of the skin and mucous membranes due to low oxygen levels in the blood.
• Hypothermia, or abnormally low body temperature.
• Cardiovascular collapse, which can manifest as low blood pressure, rapid heart rate, and shock.
• Abdominal distension and vomiting.
• Lethargy and irritability.
• Difficulty breathing and apnea, or temporary cessation of breathing.

Diagnosis

The diagnosis of Grey syndrome is primarily based on the clinical presentation and the history of chloramphenicol use. Laboratory tests may show elevated levels of chloramphenicol in the blood. In severe cases, radiography may reveal distension of the abdomen due to gas accumulation.

Treatment

The treatment of Grey syndrome involves immediate discontinuation of chloramphenicol and supportive care to manage the symptoms. In severe cases, hemodialysis may be used to remove the drug from the body. Despite treatment, the prognosis of Grey syndrome is poor, with a high mortality rate.

Prevention

The prevention of Grey syndrome involves careful use of chloramphenicol, especially in neonates and infants. The drug should be used at the lowest effective dose and for the shortest possible duration. Regular monitoring of blood levels of the drug can help prevent accumulation and the development of Grey syndrome.

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