ABSTRACT
A developmentally normal infant presented with repeated episodes of afebrile status epilepticus following nutmeg ingestion. He had developed two episodes of afebrile status epilepticus and had received different treatments earlier, but the details of treatment were not available. On admission, he redeveloped convulsions and loading doses of phenytoin, phenobarbitone and midazolam were administered. However, seizures persisted and extrapyramidal movements, nystagmus and visual dysfunction were noted. Iatrogenic phenytoin toxicity was considered and confirmed by drug levels. His symptoms completely disappeared after discontinuation of phenytoin therapy. The initial seizures were attributed to myristicin, an active component of nutmeg, because of the temporal association. However, the subsequent seizures were due to phenytoin toxicity caused by administration of multiple loading doses. This case highlights that nutmeg, a spice, can cause serious toxic effects like status epilepticus. Furthermore, treatment of status epilepticus with phenytoin can cause iatrogenic seizures due to its narrow therapeutic range.
Subject(s)
Anticonvulsants/adverse effects , Benzyl Compounds/poisoning , Dioxolanes/poisoning , Myristica/poisoning , Phenytoin/adverse effects , Pyrogallol/analogs & derivatives , Status Epilepticus/chemically induced , Allylbenzene Derivatives , Anticonvulsants/therapeutic use , Humans , Infant , Male , Phenytoin/therapeutic use , Pyrogallol/poisoning , Seizures/chemically inducedSubject(s)
Myristica/poisoning , Spices/poisoning , Allylbenzene Derivatives , Animals , Benzyl Compounds/chemistry , Benzyl Compounds/poisoning , Dioxolanes/chemistry , Dioxolanes/poisoning , Foodborne Diseases/diagnosis , Foodborne Diseases/therapy , Humans , Myristica/chemistry , Plant Poisoning/diagnosis , Plant Poisoning/therapy , Pyrogallol/analogs & derivatives , Pyrogallol/chemistry , Pyrogallol/poisoningSubject(s)
Benzyl Alcohols/poisoning , Benzyl Compounds/poisoning , Infant, Premature, Diseases/chemically induced , Adult , Benzyl Alcohol , Benzyl Alcohols/blood , Catheterization , Edema/therapy , Female , Humans , Infant, Newborn , Infant, Premature, Diseases/blood , Pregnancy , Sodium Chloride , Umbilical ArteriesSubject(s)
Benzyl Alcohols/poisoning , Benzyl Compounds/poisoning , Infant, Premature, Diseases/chemically induced , Acidosis/chemically induced , Benzyl Alcohol , Benzyl Alcohols/urine , Central Nervous System Diseases/chemically induced , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Respiratory Insufficiency/chemically inducedSubject(s)
Anti-Infective Agents/poisoning , Benzyl Alcohols/poisoning , Benzyl Compounds/poisoning , Infant, Premature, Diseases/chemically induced , Benzyl Alcohol , Benzyl Alcohols/administration & dosage , Benzyl Alcohols/metabolism , Humans , Infant, Newborn , Injections, Intravenous , Intensive Care Units, Neonatal , Respiration , SyndromeABSTRACT
Severe flaccid paraplegia accompanied by extensive sensory loss after epidural anesthesia administered for labor and delivery occurred in a previously healthy 24-year-old primagravida. Recovery was virtually complete after 16 months. The cause of the neurologic deficits may have been the 1.5 percent benzyl alcohol preservative contained in an 0.9 percent saline solution used for postdelivery epidural injection.
Subject(s)
Anesthesia, Epidural/adverse effects , Anesthesia, Obstetrical/adverse effects , Benzyl Alcohols/poisoning , Benzyl Compounds/poisoning , Paraplegia/chemically induced , Adult , Drug Compounding , Female , Humans , Pregnancy , Preservatives, Pharmaceutical/adverse effectsABSTRACT
Porphyria cutanea tarda was detected in a 44-year-old janitress. The illness was probably caused by the unintentional synthesis of a polychlorinated phenol as a result of mixing commonly available household ingredients in toilet bowls and shower stalls. Although the evidence for this hypothesis is circumstantial, its likelihood and the wide-spread household use of these reagents justify calling attention to the innovative misuse of disinfectants as a potential source of toxic exposure.
