[Cibalen poisoning in an infant]. / Cibalen-Intoxikation bei einem Säugling.

A toxicological investigation of urine could finally explain abnormal neurological symptoms with apnea. 2 Cibalen-suppositories for children were given to an 7 week old infant as treatment of an upper respiratory infect. 12 hours were between the application of the 2 suppositories. 2 hours after the second application coma, hypertonus, opisthotonus, miosis and depression of ventilation were found. 10 hours later an apnea occurred. These symptoms were due to the synergistic effect of Phenobarbital, Aminophenazon and Codeinphosphat in an overhigh dose.

[Combined propyphenazone and codeine poisoning in childhood (analysis of 6 patients with Spasmoplus poisoning)]. / Kombinierte Prophyphenazon- und Codeinvergiftung im Kindesalter (Analyse von 6 Patienten mit Spasmoplus-Vergiftung).

The case histories are presented of 6 patients with accidental poisoning by Spasmoplus suppositories. The main toxic constituents are codeine and the pyrazolone derivative, propyphenazone. All patients had symptoms of codeine intoxication with somnolence, miosis and oedema, 2 patients had also symptoms of prophyphenazone intoxication with hypotension, coma and convulsions. 1 patient died during the acute stage in a state of shock, with arrhythmia, and asystole.

Acute toxicity of pyrazolones.

Pyrazolone intoxication accounts for most (52 percent) mild analgesic poisonings in West Germany. Severe and fatal intoxication with pyrazolones is, however, rare. In the German literature, only 50 cases have been described in the past 62 years; 80 to 90 percent of these were caused by aminopyrine, which was withdrawn from the West German market in 1978 and replaced by propyphenazone. Up to now, no fatal poisoning with propyphenazone has been reported. However, the signs and symptoms of severe intoxication are similar for both propyphenazone and aminopyrine. The acute toxicity of dipyrone is slightly lower than that of propyphenazone, whereas phenylbutazone and oxyphenbutazone clearly cause less severe reactions. Characteristic symptoms include impaired consciousness progressing to coma, and convulsions. In addition, arrhythmia and cardiogenic shock may occur. Severe aminopyrine intoxication may also be complicated by sudden apnea. Liver damage may develop after a latent period of about 24 hours, especially after phenylbutazone and oxyphenbutazone poisoning. Therapy involves supportive measures as well as gastric emptying by emesis or lavage, installation of medical charcoal, and induction of diarrhea or gut lavage. Although exact clinicotoxicologic data on hemoperfusion are not available as yet, distribution volumes, plasma half-lives, and endogenous plasma clearances as well as results of in vitro trials all suggest the efficacy of this procedure. Hemoperfusion with uncoated amberlite XAD-4 resin is, therefore, recommended for patients with severe pyrazolone intoxication.

Intoxication with pyrazolones.

1 About 50 severe or fatal (mostly accidental) cases of intoxication in children by pyrazolones have been reported in the German literature of the past 59 years. 2 Characteristic symptoms are impaired consciousness progressing to coma and convulsions. In addition, sudden apnoea and cardiac arrest may occur. Hepatic lesions may develop after a latent period of 12-24 hours. 3 Haemoperfusion seems to be the only therapeutic measure which is able to reduce the total body load of all pyrazolones to a toxicologically relevant extent. Actual clinico-toxicological data from poisoned patients are not available as yet; however, distribution volumes, plasma half-lives and endogenous plasma clearances as well as removal kinetics in vitro of aminophenazone (aminopyrine), propyphenazone, metamizole (dipyrone), phenylbutazone and oxyphenbutazone as point to the efficacy of haemoperfusion with amberlite XAD-4 resin.

[Spasmopuls -intoxication in infancy (successful treatment by blood exchanged transfusion) (author's transl)]. / Spasmoplus -Intoxikation im Säuglingsalter (Erfolgreiche Behandlung durch Austauschtransfusion)

An intoxication by Spasmoplus in a four weeks old infant is reported. The suppository was given believing it was a laxative. A few hours later symptoms of a Codein-intoxication were present. 24 hours after that time the situation was extremely dangerous by means of the intoxication by aminophenazon. Lifesaving was blood exchange transfusion.

[Atypical late onset of clinical symtoms after phenylbutazone/amidopyrine ingestion (author's transl)]. / Ungewöhnlicher Verlauf einer Phenylbutazon-Aminophenazon-Intoxikation

A 33 month old healthy girl accidently took 1.5 g phenylbutazone and 2.6 g aminopyrine. She was treated with gastric lavage and forced diuresis. No clinical symptoms were discovered for 17 hours after drug ingestion. She then developed generalized convulsions. After 19 hours reddish discoloration of urine was observed for first time. High serum transaminase indicated later on a toxic hepatocellular damage. It is recommended to treat patients with phenylbutazone aminopyrine insgestions for at least 24 hours even in the absence of reddish urine discoloration and clinical symptoms.