ABSTRACT
BACKGROUND: Aluminum toxicity has been reported in renal failure patients exposed to aluminum-contaminated dialysate and oral phosphate binders. We report a case of significant aluminum toxicity in a non-hemodialysis patient. CASE REPORT: A 43-year-old male IV drug user presented to the hospital with a seizure disorder of recent onset, progressive cognitive decline, ataxia, and dysarthria. The serum aluminum concentration was 180 micrograms/L (6.65 micromol/L). For 3 to 4 years prior, the patient had injected 'cooked' oral methadone. The methadone solution was heated in an aluminum pot to reduce the volume and then injected intravenously (IV). He was treated with IV deferoxamine over 9 months until he failed to return. Serum aluminum level after 9 months of treatment was 64.5 microgram/L (2.39 micromol/L). Neurological symptoms were partially improved. CONCLUSION: Chronic IV injection of oral methadone solution heated in an aluminum-based cooking utensil may result in significant aluminum toxicity.
Subject(s)
Aluminum/poisoning , Chelating Agents/therapeutic use , Deferoxamine/therapeutic use , Methadone/administration & dosage , Neurotoxicity Syndromes/etiology , Adult , Aluminum/administration & dosage , Aluminum/blood , Chelating Agents/administration & dosage , Deferoxamine/administration & dosage , Humans , Injections, Intravenous , Male , Neurotoxicity Syndromes/drug therapy , Treatment OutcomeABSTRACT
BACKGROUND: Pimozide overdose has rarely been reported in children. In adults, pimozide intoxication may cause seizures, extrapyramidal and anticholinergic effects, hypotension, QTc prolongation and torsades de pointes. We report dystonia, hypotension and drowsiness following pimozide ingestion in a child. CASE REPORT: An alert 18-month-old presented to hospital 40 minutes after ingesting up to 6 mg (0.5 mg/kg) of pimozide. Vital signs: BP 91/62 mmHg, HR 130/min, RR 26/min, temperature 97.2 degrees F (36.2 degrees C). She received gastric lavage and activated charcoal. One hour later, her QTc interval was 420 msec, HR 150. She remained asymptomatic until 12 hours post-ingestion, when she developed drooling, tongue thrusting and drowsiness. BP was 75/40, HR 150, QTc 440 msec. BP increased to 95/50 after a bolus of normal saline. Her dystonia subsided over the next 12 hours without treatment. Drowsiness and tachycardia persisted until 40 hours post-ingestion. QTc interval at this time was 370 msec. Patient recovered without sequelae. CONCLUSION: Pimozide overdose in children may be associated with delayed onset of symptoms, including dystonia.
