Multiple drugs

Abstract

Various toxicities and lack of efficacy: 4 case reports An observational, descriptive and retrospective study involving 353 patients, who presented to the paediatric emergency service due to suspicion of intoxication and received antidotes between January 2008 and June 2012, described an adolescent boy, who developed coma and respiratory depression following treatment with midazolam at a supratherapeutic dose, and he developed psychomotor agitation during treatment with flumazenil for a decreased level of consciousness; a patient, who developed neurological alteration following intoxication with valproate; a third patient exhibited a reduction of prothrombin time during treatment with acetylcysteine for paracetamol intoxication; and a 3-yearold boy exhibited lack of efficacy during treatment with hydroxocobalamin [not all ages, sexes, routes and outcomes stated; dosages and times to reaction onsets not stated]. Patient 1: The adolescent boy presented with signs of alcohol intoxication, and received IV midazolam at a supratherapeutic dose prior to hospitalisation. At the time of hospital arrival, he was in a state of coma with Glasgow score of six, and respiratory depression was also noted. The coma and respiratory depression were considered as related to midazolam toxicity. Following admission, he received treatment with flumazenil, and the coma reversed. However, he developed psychomotor agitation secondary to the flumazenil therapy. Patient 2: The patient exhibited toxic levels of valproate, which led to the development of neurological alteration. The patient received carnitine as antidote. Patient 3: The patient, who presented with paracetamol intoxication, started receiving treatment with IV acetylcysteine [N-acetylcysteine] as antidote for paracetamol intoxication. However, the patient’s prothrombin time decreased to 59.5%, which was considered as a side effect of the acetylcysteine treatment. Patient 4: The 3-year-old boy presented following inhalation of smoke from fire. He received treatment with hydroxocobalamin along with oxygen therapy and advanced cardiopulmonary resuscitation manoeuvres. However, he exhibited no response to the treatments including the hydroxocobalamin therapy, and died [exact cause of death not stated]. Author comment: Finally, one patient with toxic levels of valproate and neurological alteration received carnitine. [S]ide effects of the administration of antidotes, agitation in one patient after administration of flumazenil, and reduction of prothrombin time (prothrombin time = 59.5%) in a patient who received (acetylcysteine) intravenously. A 3-year-old boy. . .who received, without response, advanced cardiopulmonary resuscitation manoeuvres, 100% oxygen and hydroxocobalamin, died.