Clonidine Overdose in a Toddler Due to Accidental Ingestion of a Compounding Cream.

A 22-month-old girl without any significant medical history accidentally consumed a small amount of a therapeutic compounding cream that contained camphor, gabapentin, clonidine, ketoprofen, and lidocaine. Upon presentation to the emergency department, the child exhibited immediate onset of altered mental status with wide fluctuation in her vital signs, which included intermittent apnea requiring bag-valve mask assistance and endotracheal intubation. Serum laboratory analysis measured a clonidine level of 2.6 ng/mL and undetectable camphor, gabapentin, and ketoprofen levels. While on mechanical ventilation, the patient exhibited hypothermia, bradycardia, and hypotension; all of which responded to supportive care. After approximately 12 hours in the intensive care unit, the patient was successfully extubated and remained asymptomatic. This unique case of a patient with brief, unintentional oral exposure to a compounding cream, who demonstrated severe toxicity despite only a measured, supratherapeutic clonidine concentration, is discussed. Emergency physicians and pediatricians should be alert to the potential for exposure of pediatric patients to these medicinal compounds. Furthermore, parents must be made aware of the potential dangers of compounded medications and ensure their proper usage and storage.

Urinary mercury in twelve cases of cutaneous mercurous chloride (calomel) exposure: effect of sodium 2,3-dimercaptopropane-1-sulfonate (DMPS) therapy.

OBJECTIVE: To evaluate clinical symptoms and urinary mercury before and after chelation therapy in subjects with chronic cutaneous mercurous chloride (HgCl; calomel) exposure. SUBJECTS: Twelve women from 19-45 years who had used a facial cream which contained HgCl (5.9%) for 2 to 10 years. DESIGN: Twenty-four hour urine samples were collected for basal urine mercury. All the subjects received a 5-day cycle of oral sodium 2,3 dimercaptopropane-l-sulfonate (Dimaval capsules 100 mg) 200 mg/d on an outpatient basis. The urine mercury excretion was monitored 24 hours after the first dose and 72 hours after the last dose in eight subjects. RESULT: Exanthem and tremor were detected in two of 12 subjects. The range of urine mercury was 180 to 1876 micrograms/g creatinine. A significant increase in the urinary mercury excretion was observed in the first 24 hours after beginning sodium 2,3-dimercaptopropane-1-sulfonate. CONCLUSION: Chronic topical application of 5.9% HgCl cream was associated with clinical mercurialism in two subjects and with high urinary mercury level in all the cases. Sodium 2,3-dimercaptopropane-1-sulfonate was effective in increasing urine mercury.

[Acute intoxication by cosmetics]. / Les intoxications aiguës par les cosmétiques

Intoxications due to cosmetics are of various types, but certain substances may be particularly harmful, especially when the constituants include acetone, boric acid and borates, ethyl alcohol, bromates, formol, methyl alcohol, propylene glycol, thallium, thioglycolate.. Every cosmetic substance may induce accidental intoxications. Most often, fluid cosmetics are absorbed either by children or by feeble-minded subjects. In all intoxication, one must take account of the age and weight of the patient, of the quantity absorbed, of the toxicity and of the constituants of the substance.