Role of laboratory in the management of phenylbutazone poisoning.

We report a rare case of intentional overdose of phenylbutazone in a 15-yr-old female. The patient exhibited symptoms of phenylbutazone toxicity and the presence of the drug was confirmed by gas chromatography mass-spectrometry (GC-MS) analysis of the initial urine sample. The patient underwent plasmapheresis to remove the drug from the circulation. Semiquantitation of sequential serum samples by GC-MS revealed elimination of phenylbutazone by day 5 of admission at which time the plasmapheresis was discontinued. Elevated blood urea nitrogen (BUN) and creatinine returned to normal. Analysis of biomarkers for liver necrosis and regeneration in sequential serum samples revealed the restoration of normal liver function by day 5. This case further confirms our previous observations that biomarkers for liver necrosis and regeneration can predict the outcome of patients with liver damage due to toxins.

Poisoning with equine phenylbutazone in a racetrack worker.

Phenylbutazone is a potent nonsteroidal, anti-inflammatory drug often used by veterinarians to treat racetrack animals. Its use in human beings is limited because of significant adverse effects and the availability of newer, safer drugs. We report the case of a 24-year-old man who ingested 17 g of equine phenylbutazone over a 24-hour period to treat the pain of a toothache. He developed grand mal seizures, coma, hypotension, respiratory and renal failure, and hepatic injury. Serum phenylbutazone concentration obtained approximately eight hours after presentation was 900 micrograms/mL. The patient recovered during six weeks of intensive supportive care and repeated hemodialysis.

Septicemic salmonellosis and suspected phenylbutazone toxicosis in an aged pony.

A 16-year-old pony with signs of intermittent abdominal pain was treated with phenylbutazone in excess of the recommended dosage. Endoscopy revealed ulceration of the esophagus, stomach, and proximal portion of small intestine. The pony developed diarrhea. Salmonella typhimurium was isolated from the blood and feces. Treatment included fluids, trimethoprim-sulfadiazine, sucralfate, and ranitidine hydrochloride. The diarrhea resolved, as did the gastrointestinal ulceration. This case was unusual because septicemia with salmonellosis is an uncommon finding in adult equids. Also, complications commonly seen in neonatal septicemia (septic arthritis, nephritis, and hepatitis) were not observed. Phenylbutazone toxicosis and stress were considered possible causes for the gastrointestinal ulceration.

Experimentally induced phenylbutazone toxicosis in ponies: description of the syndrome and its prevention with synthetic prostaglandin E2.

Phenylbutazone (PBZ) toxicosis was induced in 9 ponies to further define the clinical and pathologic changes occurring with this syndrome. Six additional ponies were treated with PBZ and a synthetic prostaglandin E2 to determine the role of prostaglandins in the pathogenesis of PBZ toxicosis. Ponies given only PBZ exhibited CNS depression, anorexia, weight loss, diarrhea, cyanotic mucous membranes, and oral ulcers. Total serum protein concentration gradually decreased during the 10-day treatment period. Marked mucosal atrophy, focal erosions, and ulcers characterized the lesions in the alimentary tract. Ponies given PBZ and prostaglandin E2 remained clinically healthy and did not develop hypoproteinemia or mucosal atrophy. A few erosions were seen, but ulcers were not observed. The results of the present study indicate that mucosal atrophy is a characteristic lesion of PBZ toxicosis. It is also evident that inhibition of prostaglandin synthesis has an important role in the development of this syndrome.

[An undesirable drug interaction in horses? Complications which can occur during the administration of coumarin derivatives and phenylbutazone]. / Een ongewenste interactie van geneesmiddelen bij het paard? Complicaties, die tijdens de toepassing van cumarine-derivaten en fenylbutazon kunnen optreden.

A study of the literature was done because of questions asked in a court of justice concerning possible poisoning in a jumper, resulting from administration of both phenylbutazone and a coumarin derivative within a particular period. In view of the mechanisms of action and the pharmacokinetic characteristics of the agents, these forms of combined treatment are also highly inadvisable in horses.

Clinical features and management of analgesic poisoning.

Analgesic poisoning is a common medical emergency, and these drugs account for about 30% of self-poisoning in adults. Aspirin and paracetamol are taken most often, and can cause significant morbidity and mortality. However, problems with the hepatotoxicity of paracetamol have been greatly reduced by the introduction of effective treatment with agents such as N-acetylcysteine. The non-steroidal anti-inflammatory analgesics are not commonly taken in overdosage but the incidence of self-poisoning with mefenamic acid is increasing at an alarming rate. With the exception of phenylbutazone and mefenamic acid these drugs rarely seem to cause serious toxicity. The narcotic analgesics can cause profound respiratory depression and are the most dangerous drugs in overdosage.

Vascular pathology in phenylbutazone intoxicated horses.

Three mature Thoroughbred geldings were given 13.63 mg phenylbutazone/Kg bodyweight intravenously for 3 days and repeated in one horse 4 days later. After 4, 7 and 10 days (double treatment), degeneration of the wall of small veins occurred in all horses. The veins were dilated and/or showed hyalin degeneration. The phlebopathy was interpreted to be paramount in phenylbutazone intoxication. All other manifestations, including erythro- and leukodiapedesis, submucosal edema and ulceration of the gastrointestinal mucosa, phlebothrombosis and significant changes in the hemogram and serum chemistry, were considered secondary to the vein lesions.

Effects of toxic doses of phenylbutazone in ponies.

Toxic doses of phenylbutazone (10 mg/kg of body weight) were administered to 10 ponies once daily for 14 days. Clinical signs of toxicosis similar to those seen in other species included CNS depression, anorexia, oral ulcers, and soft feces. Six ponies died in 7 to 20 days; 1 pony was euthanatized during an acute abdominal crisis; and 3 ponies survived the study. At necropsy, the major lesions were oral and gastrointestinal ulcerations and renal changes.

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.

Acute phenylbutazone poisoning in a child.

Accidental acute intoxication with phenylbutazone in a 2 1/2-year-old child produced an acute picture of coma, convulsions, diarrhoea, and of cholestatic jaundice which evolved over the succeeding 10 days. Transient, unexplained hyperglycaemia occurred during the first few hours of the illness. Recovery was complete within three weeks after the poisoning. Her clinical progress was monitored with the aid of regular estimations of plasma phenylbutazone levels.

Phenylbutazone toxicosis in equidae: a biochemical and pathophysiological study.

Toxic effects of phenylbutazone (PBZ) in ponies and horses were studied, using a variety of biochemical, pathophysiologic, and pathologic methods. At dosage levels of 10 to 12 mg/kg of body weight/day for 8 to 10 days, ponies frequently developed clinical signs of toxicosis characterized by hypoproteinemia. Studies using 51CrCl3 demonstrated that PBZ caused a protein-losing gastroenteropathy. The plasma loss was usually associated with gastrointestinal ulceration, but sometimes occurred without obvious lesions in mildly affected animals. Similar studies (8.2 mg/kg/day for 13 days) in Thoroughbreds indicated that they were less susceptible to PBZ toxicity; however, a degree of hypoproteinemia occurred in 4 of 6 treated Thoroughbreds.