RESUMEN
Topical ocular medications have been widely prescribed and successfully used in children for the management of different ophthalmic disorders. We present 2 infants admitted to our pediatric intensive care unit who developed altered state of consciousness, hypotonia, hypothermia, bradycardia, and apnea after instillation of ophthalmic drops. The second infant also had hypotension and broncho-obstruction. Few days before admission, both infants were diagnosed with congenital glaucoma, and topical antiglaucoma treatment was initiated. Ophthalmic drops with brimonidine and brinzolamide were prescribed to both patients, whereas the second infant also received topical timolol. After elimination of other possible causes, the diagnosis of intoxication with topical antiglaucoma medications was established. After discontinuation of eye drops and vigorous symptomatic treatment, both infants recovered without sequels. Topically applied ophthalmic drops may cause life-threatening systemic adverse effects in infants, such as central nervous system depression and cardiogenic shock. Moreover, these 2 patients illustrate the importance of careful evaluation of all topical medications and their consideration as possible causes of the derangements in critically ill infants.
Asunto(s)
Apnea/inducido químicamente , Trastornos de la Conciencia/inducido químicamente , Soluciones Oftálmicas/envenenamiento , Quinoxalinas/envenenamiento , Choque Cardiogénico/inducido químicamente , Sulfonamidas/envenenamiento , Tiazinas/envenenamiento , Timolol/envenenamiento , Absorción , Administración Oftálmica , Bradicardia/inducido químicamente , Tartrato de Brimonidina , Relación Dosis-Respuesta a Droga , Combinación de Medicamentos , Urgencias Médicas , Femenino , Glaucoma/congénito , Glaucoma/tratamiento farmacológico , Humanos , Hipotermia/inducido químicamente , Lactante , Hipotonía Muscular/inducido químicamente , Mucosa Nasal/fisiología , Soluciones Oftálmicas/farmacocinética , Quinoxalinas/administración & dosificación , Quinoxalinas/farmacocinética , Quinoxalinas/uso terapéutico , Sulfonamidas/administración & dosificación , Sulfonamidas/farmacocinética , Sulfonamidas/uso terapéutico , Tiazinas/administración & dosificación , Tiazinas/farmacocinética , Tiazinas/uso terapéutico , Timolol/administración & dosificación , Timolol/farmacocinética , Timolol/uso terapéuticoRESUMEN
We report on an accidental intoxication with cyclopentolate eye drops. A 90-year-old patient became confused and was admitted to the emergency department. His symptoms consisted of disorientation, ataxia, and psychomotor agitation. Similar cases have been described in the literature. With this case report we would like to draw attention to this little known differential diagnosis when confronted with confused patients.
Asunto(s)
Confusión/inducido químicamente , Confusión/diagnóstico , Ciclopentolato/toxicidad , Soluciones Oftálmicas/envenenamiento , Anciano de 80 o más Años , Confusión/prevención & control , HumanosRESUMEN
Tetrahydrozoline is an imidazoline derivative with alpha receptor agonist activity widely available in over-the-counter topical ocular and nasal formulations. More than 1,600 cases of oral exposures are reported to United States poison centers annually (1,2). Reports of significant toxicity from tetrahydrozoline ingestion are unusual but have occured primarily in small children after unintentional ingestion (3-63, 6). We report a case of unintentional tetrahydrozoline ingestion with cardiovascular effects persisting for 36 hours.
Asunto(s)
Bradicardia/inducido químicamente , Frecuencia Cardíaca/efectos de los fármacos , Imidazoles/envenenamiento , Administración Oral , Adolescente , Bradicardia/fisiopatología , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Imidazoles/administración & dosificación , Errores de Medicación , Soluciones Oftálmicas/administración & dosificación , Soluciones Oftálmicas/envenenamiento , Autoadministración , Factores de TiempoRESUMEN
Brimonidine is an ophthalmic solution of 0.2% brimonidine tartrate used to lower intraocular pressure in human glaucoma patients. A retrospective study was conducted of brimonidine ophthalmic solution ingestion in 52 dogs reported to the ASPCA Animal Poison Control Center between January 1998 and December 2000. Eighty percent of the dogs were < 1-y of age. Approximate ingested dosages ranged from 0.18-5.55 mg/kg. Incidence of clinical signs were bradycardia (67%), depression (46%), ataxia (27%), hypotension (25%), pallor (23%), weakness (17%), change in mucous membrane color (17%), hypothermia (13%), vomiting or retching (13%.). Shock, weak pulses, and poor capillary refill time were also reported. Treatment involved early decontamination, supportive care, andyohimbine and atipamezole as specific alpha-2 antagonists that could be helpful in reversing the effects of brimonidine. Due to the possibility of severe cardiovascular effects developing, the ingestion of brimonidine ophthalmic solution in dogs should be considered dangerous.
Asunto(s)
Agonistas alfa-Adrenérgicos/envenenamiento , Soluciones Oftálmicas/envenenamiento , Quinoxalinas/envenenamiento , Administración Oral , Agonistas alfa-Adrenérgicos/metabolismo , Animales , Tartrato de Brimonidina , Perros , Humanos , Soluciones Oftálmicas/metabolismo , Intoxicación/fisiopatología , Intoxicación/terapia , Quinoxalinas/metabolismoRESUMEN
A 1-month-old infant with Peters anomaly had recurrent episodes of unresponsiveness, hypotension, hypotonia, hypothermia, and bradycardia. An extensive medical evaluation determined these episodes to be caused by brimonidine, an anti-glaucoma agent. There is the potential for serious toxic effects from the systemic absorption of topically applied ophthalmic agents in children.
Asunto(s)
Agonistas alfa-Adrenérgicos/envenenamiento , Coma/etiología , Soluciones Oftálmicas/envenenamiento , Quinoxalinas/envenenamiento , Agonistas alfa-Adrenérgicos/administración & dosificación , Tartrato de Brimonidina , Coma/complicaciones , Coma/prevención & control , Anomalías del Ojo/complicaciones , Humanos , Recién Nacido , Masculino , Soluciones Oftálmicas/administración & dosificación , Guías de Práctica Clínica como Asunto , Quinoxalinas/administración & dosificación , SíndromeAsunto(s)
Depresores del Sistema Nervioso Central/envenenamiento , Enfermedades del Sistema Nervioso Central/inducido químicamente , Imidazoles/envenenamiento , Soluciones Oftálmicas/envenenamiento , Enfermedades del Sistema Nervioso Central/terapia , Preescolar , Lavado Gástrico , Humanos , Masculino , Respiración Artificial , Simpatomiméticos/envenenamientoRESUMEN
Eye drops are very commonly prescribed but their potential for systemic absorption and serious toxicity may be forgotten. This paper examines patterns of prescription of eye drops in Scotland by general practitioners. A review of the serious systemic features and toxicity, and their management, of commonly used eye drops is undertaken. Practical recommendations for the monitoring of such effects in clinical practice are made.