Death as a result of an adverse reaction from nalidixic acid.

This article reports a death occurring in an apparently healthy, 27-year-old male as a consequence of an adverse reaction to a common urinary tract antibiotic (nalidixic acid). The deceased had cardiac enlargement at autopsy. The clinical presentation before his sudden death coincides with the occurrence of seizures and psychotic reaction as an adverse reaction to the injection of the drug, rather than merely a result of cardiac symptoms.

Lactic acidosis, hyperglycaemia and convulsions following nalidixic acid overdosage.

A woman survived ingestion of 32 g nalidixic acid despite developing lactic acidosis, hyperglycaemia, convulsions and abnormal behaviour. The maximum recorded plasma concentration of nalidixic acid was 185 mg/l and the elimination half-life was 3.2 h. Carboxy-nalidixic acid was demonstrated in the plasma. Previously reported cases of nalidixic acid overdosage are reviewed.

[Poisoning by nalidixic acid in children]. / Intoxicación por ácido nalidíxico en niños.

A review was made of the clinical histories of 18 children who were admitted to the Emergency Department of the Hospital de Pediatría del C.M.N. (IMSS) with the diagnosis of nalidixic acid intoxication. The study covered a period of 3 years, from 1976 through 1978. There were no differences as to sex; infants under one year were most frequently attached; iatrogenesis was the most frequent mechanism. The clinical manifestations were characterized by neurological disorders of the state of alertness, hypertensive cranial syndrome and neuronal damage; there was metabolic acidosis in other cases. Treatment included gastric lavage, general measures, correction of acid-base unbalance, control of convulsive crises. Indications for the use of nalidixic acid are reviewed stressing that it must be used in urinary infections and as second choice drug.

Metabolic acidosis and coma due to an overdose of nalidixic acid.

A case of severe metabolic acidosis and coma after taking 28 g of nalidixic acid is described. After administration of 600 mEq of sodium bicarbonate the patient developed a respiratory alkalosis with secondary tetany. She recovered her state of consciousness nine hours later and the acid-base disturbance resolved after sixty hours.

[Nalidixic acid intoxication in two pregnant bitches (author's transl)]. / Nalidixinezuur intoxicatie bij twee drachtige teven.

To ensure prolonged survival, dogs with cyclic neutropenia should be protected against bacterial infection of exogenous or endogenous origin, particularly during the neutropenic episodes. One of the methods available to minimize the risk of infection in these dogs, is selective decontamination of the gastrointestinal tract by using antibiotics and/or chemotherapeutic agents, in conjunction with housing in a laminar-flow cabinet. Two pregnant bitches, some of the offspring of which were expected to be homozygous for the cyclic neutropenia allele, were decontaminated with nalidixic acid. Fourteen days after initiation of the antibacterial treatment, the two dogs died. Jaundice and seizures had been apparent in both animals prior to death. Histopathological examination revealed changes primarily in the liver, which were consistent with toxic hepatic necrosis and were characterized by severe centrilobular haemorrhage and disappearance of hepatocytes. Multiple haemorrhages were observed in other organs. Further clinical investigation in two other dogs strongly suggested that nalidixic acid was the cause of death in the two pregnant bitches.

[Acute nalidixic acid poisoning in children]. / Intoxication aigue par l'acide nalidixique chez l'enfant.

A 31 month old child developed seizures 30 minutes after the accidental ingestion of toxic quantities of nalidixic acid. The case is unusual because of the age of the patient and the circumstances of the poisoning. It emphasises that this drug is contraindicated in children with previous neurological disease.