RESUMEN

CASE DESCRIPTION A 2-year-old sexually intact female mixed-breed dog was evaluated at an emergency hospital approximately 5 hours after ingestion of an unknown amount of over-the-counter topical hair growth promoter containing 5% minoxidil foam. Vomiting and signs of lethargy were reported by the owner, and physical examination revealed tachycardia and hypotension. No treatments were performed, and the dog was transferred to a veterinary referral hospital for management of suspected minoxidil toxicosis. CLINICAL FINDINGS On arrival at the referral hospital, the dog was tachycardic (heart rate, 200 to 220 beats/min) and hypotensive (systolic arterial blood pressure, 70 mm Hg). Electrocardiography revealed a regular, narrow-complex tachycardia with no evidence of ventricular ectopy. TREATMENT AND OUTCOME Hypotension was effectively managed with a constant rate infusion of dopamine hydrochloride (12.5 µg/kg/min [5.7 µg/lb/min], IV). Once normotensive, the dog remained tachycardic and a constant rate infusion of esmolol hydrochloride (40 µg/kg/min [18.2 µg/lb/min], IV) was initiated for heart rate control. A lipid emulsion was administered IV as a potential antidote for the toxic effects of the lipophilic minoxidil, with an initial bolus of 1.5 mL/kg (0.7 mL/lb) given over 15 minutes followed by a continuous rate infusion at 0.25 mL/kg/min (0.11 mL/lb/min) for 60 minutes. While hospitalized, the dog also received maropitant citrate and ondansetron. Resolution of clinical signs was achieved with treatment, and the dog was discharged from the hospital 36 hours after admission. Four days later, the owner reported that the dog had made a full recovery and had returned to its typical behavior and activity level at home. CLINICAL RELEVANCE To the authors' knowledge, this is the first report of successful clinical management of accidental minoxidil toxicosis in a dog.

Asunto(s)

Asunto(s)

RESUMEN

OBJECTIVES: It has been suggested that ingestion of even small amounts of minoxidil by young children may result in serious adverse effects. The intent of this study was to describe pediatric minoxidil exposures reported to a statewide poison center system. METHODS: Cases were minoxidil exposures among patients 5 years or younger reported to Texas poison centers during 2000 to 2014. The distribution by various demographic and clinical factors was determined. RESULTS: Of 125 total cases, 58% were male and 78% aged 1 to 2 years. Ingestion alone was reported in 92% of the exposures. Ninety-eight percent of the exposures were unintentional, and 94% occurred at the patient's own residence. Sixty-two percent of the patients were managed on site. The outcome was not serious (no effect, minor effect, not followed [nontoxic], not followed [minimal effects]) in 88% of the exposures. The most common adverse effect was vomiting, reported in 8% of the exposures. The most common treatments were dilution/irrigation/wash (53%), activated charcoal (18%), food/snack (17%), and intravenous fluids (8%). CONCLUSIONS: Few pediatric minoxidil exposures were reported to Texas poison centers. Of these exposures, most involved ingestion, were unintentional, and involved patients who were male and aged 1 to 2 years. Although it has been suggested that pediatric minoxidil ingestions might result in serious adverse effects, this study suggests that most pediatric minoxidil exposures reported to poison centers are not likely to have serious outcomes and may be managed at home.

Asunto(s)

RESUMEN

Hypotension and persistent tachycardia in a young girl after ingesting minoxidil cutaneous solution intended for her father.

Asunto(s)

RESUMEN

A 26-year-old man was found unable to move after oral consumption of 120 mL of RiUP X5® (containing 5 g/100 mL minoxidil) as a suicidal attempt. The patient complaining of frequent vomiting and weakness was transferred to our hospital. Findings on arrival: GCS E4V5M6; respiratory rate 24/ min; blood pressure 83/43 mmHg; pulse 152/min, regular; SpO297% (oxygen by mask: 6 L/min); thus, the patient was in shock. The systolic blood pressure and the pulse rate improved to about 90 mmHg and to about 130/min, respectively, in response to rapid intravenous infusion of 2,000 mL of lactated Ringer's solution. His circulatory condition tended to improve with parenteral fluid infusion alone. Forty hours after admission, however, heart failure developed due to excessive I.V. fluid infusion and abnormal body fluid distribution associated with delayed vascular smooth muscle relaxation; therefore, mechanical ventilation was initiated. Simultaneously, intravenous noradrenaline infusion was started because of a fall of the blood pressure. Subsequently, as the patient's respiratory and circulatory conditions gradually improved, he was weaned from mechanical ventilation, and the noradrenaline infusion was discontinued at 108 hours after admission. The patient made favorable progress and was discharged home on the 9th hospital day. Minoxidil exerts adverse effects mainly on the cardiovascular system. Since minoxidil is an over-the-counter drug readily available to the public, and emergency physicians should be aware of its severe toxicity.

Asunto(s)

RESUMEN

BACKGROUND: Minoxidil (Rogaine®) is a direct vasodilator that can cause significant toxicity when ingested. We report a case of ingestion of topical minoxidil [Rogaine® (Johnson & Johnson Healthcare Products, Division of McNeil-PPC, Inc)] resulting in refractory hypotension that was successfully managed with the oral α (1) agonist midodrine. CASE REPORT: A 48-year-old male who ingested an eight ounce bottle of Rogaine® presented to the emergency department. The patient presented with a blood pressure of 57/45 mmHg and a pulse of 84 beats per minute. The patient received IV fluids and multiple vasopressors to maintain an adequate mean arterial pressure. Midodrine, an oral α (1) vasopressor, was added 10 hours post ingestion and was able to maintain an adequate mean arterial pressure. Over the next two days, midodrine was titrated down as his blood pressure returned to baseline. CONCLUSION: Midodrine may serve as an additional option to treat toxicant induced hypotension.

Asunto(s)

RESUMEN

Accidental intoxications in children are frequent but most of them are without serious consequences. We describe herein the case of a young girl who drank 100 mg of a topical hair lotion with minoxidil. On arrival, she had no symptoms except flush on the face and ears. Four and half hours after ingestion, tachycardia appeared with a pulse above 170 beats per min with hypotension at 76/24 mmHg. The heart rate remained between 170 and 190 beats per min for 12 h and then lowered to between 140 and 160 beats per min. Thirty-six hours after ingestion, the heart beat was at 140 beats per min. Minoxidil is a strong vasodilator used first in the 1970s for severe hypertension. It produces hypotension by direct arteriolar vasodilatation. Only a few cases of minoxidil intoxication have been described in the literature, including only one pediatric case. This young boy had only tachycardia of 160 beats per min for 40 h. Most serious cases have been described in adults. They suffered long-lasting tachycardia, hypotension, and ECG changes. Most patients need a bolus of normal saline fluid and some with hemodynamic problems need vasoactive drugs such as dopamine and/or phenylephrine. All patients need to be under medical supervision for a long time because of the product's very long action.

Asunto(s)

RESUMEN

CASE REPORT: Minoxidil is a potent arterial vasodilator used in the treatment of hypertension. A side effect, hypertrichosis, has prompted the marketing of a topical preparation, Rogaine, for the treatment of male-pattern baldness. Recently, a 5% solution of minoxidil became available over-the-counter as Rogaine Extra Strength For Men Hair Regrowth Treatment. We describe an oral overdose of minoxidil 3 g as the Rogaine Extra Strength preparation. Toxicity manifested as profound hypotension, requiring vasopressor support, intubation, prolonged tachycardia, and fluid overload with pleural effusions, requiring several days of therapy with furosemide. This is the largest reported ingestion of minoxidil and the first reported overdose of the extra strength 5% solution.

Asunto(s)

RESUMEN

A 52-year-old man ingested 60 ml of 2 percent topical minoxidil solution resulting in severe hypotension and tachycardia. He was resuscitated with intravenously administered crystalloid solution and treated with intravenously administered dopamine, resulting in a partial hemodynamic improvement. Further treatment with intravenously administered phenylephrine infusion resulted in resolution of hypotension. The patient suffered a non-Q-wave myocardial infarction as a result of the ingestion. The toxicity of this increasingly common preparation is profound.

Asunto(s)

RESUMEN

A 20-year-old female ingested an unknown quantity of minoxidil tablets as a suicide gesture. She presented to the emergency department about 90 minutes later with tachycardia, diffuse T wave inversion, and S-T segment depression on the ECG, labile hypotension, and a substantially elevated total serum minoxidil concentration of 3140 ng/mL. She responded to supportive therapy with intravenous fluids, and was discharged 32 hours later with stable blood pressure and mild residual tachycardia. The clinical toxicology, treatment, and previous case reports of minoxidil overdose are reviewed.

Asunto(s)

RESUMEN

A 36-year-old man ingested several products, including a topical minoxidil solution. Within two hours of the ingestion the patient was difficult to arouse, tachycardic, and hypotensive with a systolic BP of 90 mmHg. Dopamine was required for two days to maintain his BP. Swan-Ganz catheter measurements demonstrated an increased cardiac output and decreased systemic vascular resistance. The estimated amount of minoxidil ingested was 1,000 mg. The patient recovered fully and was discharged nine days after the ingestion. The severity of symptoms and the prolonged duration of toxicity are disturbing because this product is becoming increasingly more popular and available.

Asunto(s)

Asunto(s)