Fomepizole Treatment of Ethylene Glycol Poisoning in an Infant

Baum, Carl R.; Langman, Craig B.; Oker, Elif E.; Goldstein, Craig A.; Aviles, Sandra R.; Makar, Jasmin K.

doi:10.1542/peds.106.6.1489

Cited by 24 publications

(15 citation statements)

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“…Nystagmus has been reported in one case [3]. Table 2 gives an overview of all reported paediatric cases of toxic alcoholic poisoning in which fomepizole was used [2,3,4,7,8,10,11,15,20]. As demonstrated in this small case series, its administration promoted a favourable outcome and no serious sideeffects were observed in all reported cases.…”

Section: Discussionmentioning

confidence: 70%

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Fomepizole as a therapeutic strategy in paediatric methanol poisoning. A case report and review of the literature

et al. 2004

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Section: Discussionmentioning

confidence: 70%

“…In 1997, the Food and Drug Administration (FDA) in the United States of America approved it for use in ethylene glycol poisoning in adults [2]. Its use has not been widely reported in children.…”

Section: Discussionmentioning

confidence: 99%

Fomepizole as a therapeutic strategy in paediatric methanol poisoning. A case report and review of the literature

et al. 2004

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“…On the other hand, there are investigations which report that it has disadvantages such as CNS depression and hypoglycemia (7). Nevertheless, fomepizole is said to be effective in ethylene glycol intoxications in newborns (12,13). Hemodialysis can be necessary for patients with renal failure or resistant metabolic acidosis (7).…”

Section: Ethylene Glycolmentioning

confidence: 99%

“…Fomepizole administration and hemodialysis have been performed in a pediatric case at the age of 8 months to correct acidosis and oxalate crystaluria that developed due to the ingestion of more than 120 mL ethylene glycol. Following fomepizole and hemodialysis, acidosis was corrected by preventing the conversion of ethylene glycol to toxic metabolites, and the patient has been reported to have improved within 48 hours (12). However, there are reports that show that fomepizole administered at a dose of 10 mg/kg every 12 hours following a loading dose of 15 mg/kg was also successful without any need for hemodialysis in newborns (13).…”

Section: Ethylene Glycolmentioning

confidence: 99%

Evaluation of Common Non-pharmacological Chemical Substance Poisonings in Childhood

Ünüvar¹

2017

jpr

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Songül Ünüvar ABS TRACTÖz Acute intoxications in adolescents and adults are mostly associated with intentional or accidental ingestions. Intoxications are commonly seen in children aged between 1 and 5 years and most of the cases are associated with accidental intake. In most of the children, no clinical symptoms related to intoxication are observed or only mild effects can develop. The main route of drug elimination is through kidneys. Absolute clearance in children is often lower than in adults but weight-adjusted clearance is higher. Depending on more rapid elimination in children the plasma half-life of the drug might be shorter in children than in adults. A shorter elimination half-life means that plasma steady-state is achieved with repeated doses. It is important to prevent childhood intoxications, and the use of child-resistant packaging and adequate supervision together with the secure storage of household substances are the basis of prevention of accidental childhood intoxications. Intoxications represent one of the most common medical emergencies in children, and epidemiological characteristics vary in different countries. Therefore, special epidemiological surveillance is necessary for each country to determine the problem according to which preventive measures should be taken. Early awareness and taking appropriate therapeutic measures seems to be effective in the reduction of mortality rate. The major and most common non-pharmacological chemical intoxications in childhood have been reviewed here with the intent of helping health-care professionals, particularly pediatricians to recognize and reduce the risk of harmful childhood intoxications. Keywords: Childhood, intoxication, child health, antidote Ergen ve yetişkinlerdeki akut zehirlenmeler çoğunlukla kasıtlı veya kazara alımlar ile ilişkilidir. Bir ve beş yaş arasındaki çocuklarda zehirlenmeler yaygın görülmektedir ve olguların çoğu kazara alımlara bağlıdır. Çocukların çoğunda zehirlenmeye bağlı hiçbir klinik belirti gözlenmez veya sadece hafif etkiler gelişebilir. İlaç eliminasyonu esas olarak böbrekler aracılığı ile olur. Çocuklarda mutlak klerens yetişkinlere göre genellikle daha düşüktür, fakat vücut ağırlığına göre hesaplanan klerens daha yüksektir. Çocuklarda daha hızlı eliminasyona bağlı olarak, ilacın plazma yarı ömrü yetişkinlere kıyasla daha kısa olabilir. Eliminasyon yarı-ömrünün daha kısa olması, plazma kararlı durumuna tekrarlanan dozlarda ulaşıldığı anlamına gelir. Çocukluk çağı zehirlenmelerinin önlenmesi önemlidir, çocuk emniyeti olan ambalaj kullanılması ve evsel ürünlerin kontrollü olarak güvenli muhafaza edilmeleri, kazara oluşan çocukluk çağı zehirlenmelerinin önlenmesinin esasını oluşturur. Zehirlenmeler, çocukluk çağında en sık görülen acil tıbbi durumlardan biridir ve epidemiyolojik özellikleri ülkeden ülkeye farklılık göstermektedir. Bu nedenle, sorunu belirlemek için hangi önleyici tedbirlerin alınabileceği konusunda her ülke için özel epidemiyolojik takip gereklidir. Zehirlenmelerde erken farkındalık ve uygun terapötik ...

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“…2 Although clinical experience with fomepizole has been expanding, its use in children remains uncommon and is limited to cases of ethylene glycol toxicity. [3][4][5][6] We report a case of methanol poisoning in a child who was treated with fomepizole. Fomepizole obviated the need for intravenous ethanol infusion, prevented metabolic acidosis as well as neurotoxicity, and produced no discernible adverse effects.…”

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confidence: 99%

Childhood Methanol Ingestion Treated With Fomepizole and Hemodialysis

et al. 2001

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ABSTRACT. Fomepizole (4-methylpyrazole; Antizol) is used increasingly in the treatment of methanol toxicity in adults. Little experience exists with this drug in the pediatric population, however. We present a case of methanol poisoning in a child in whom the use of fomepizole averted intravenous ethanol infusion and the attendant side effects of this therapy. Pediatrics 2001;108(4). URL: http://www.pediatrics.org/cgi/content/full/108/4/e77; 4-methylpyrazole, fomepizole, Antizol, methanol, pediatric.ABBREVIATION. ADH, alcohol dehydrogenase. M ethanol may produce severe morbidity and mortality if undetected or treated improperly. In 1999, more than 970 methanol exposures were reported to poison centers in the United States, with 363 exposures occurring in the pediatric population. 1 Formerly, treatment for methanol poisoning required intravenous ethanol infusion, hemodialysis, or both. Fomepizole (4-methylpyrazole, Antizol) was approved recently by the Food and Drug Administration as an antidote for methanol poisoning in adults. 2 In 1 case series of patients who were poisoned with methanol, fomepizole eliminated the need for ethanol therapy, although many still required hemodialysis. 2 Although clinical experience with fomepizole has been expanding, its use in children remains uncommon and is limited to cases of ethylene glycol toxicity. [3][4][5][6] We report a case of methanol poisoning in a child who was treated with fomepizole. Fomepizole obviated the need for intravenous ethanol infusion, prevented metabolic acidosis as well as neurotoxicity, and produced no discernible adverse effects. CASE REPORTA 5-year-old male ingested an unknown amount of windshield washer fluid (40% solution of methanol) that was stored improperly in a sports drink bottle. He was brought to a local emergency department within 60 minutes of the ingestion. Initial vital signs were as follows: temperature, 37°C; pulse, 101 beats per minute; blood pressure, 101/59 mm Hg; respiratory rate, 22 breaths per minute. He weighed 24.5 kg. Physical examination was normal with no signs of intoxication or ophthalmologic abnormality.Initial laboratory evaluation revealed a normal complete blood count. Serum chemistries were as follows: sodium, 134 mEq/L; potassium, 3.7 mEq/L; chloride, 110 mEq/L; bicarbonate, 23 mEq/dL; blood urea nitrogen, 12 mg/dL; creatinine, 0.5 mg/dL; and glucose, 136 mg/dL. Anion gap was 4.7 mEq/dL. The serum osmolality was 320 mOsm/kg H 2 O; the calculated serum osmolarity was 284 mOsm/kg H 2 O, yielding an osmolal gap of 36 mOsm/kg H 2 O. Plasma aspirin, acetaminophen, and ethanol were negative. Serum methanol concentration measured by gas chromatography was 35 g/dL.Transfer to a tertiary care center was arranged. On arrival to the referral intensive care unit, he complained of intermittent abdominal pain, was slightly confused, and was tachypneic. An arterial blood gas was as follows: pH, 7.43; Pco 2 , 36 mm Hg; Po 2 , 137 mm Hg. Serum bicarbonate was 20. Eight hours after the ingestion, the child received a 15 mg/kg intrav...

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Fomepizole Treatment of Ethylene Glycol Poisoning in an Infant

Cited by 24 publications

References 3 publications

Fomepizole as a therapeutic strategy in paediatric methanol poisoning. A case report and review of the literature

Fomepizole as a therapeutic strategy in paediatric methanol poisoning. A case report and review of the literature

Evaluation of Common Non-pharmacological Chemical Substance Poisonings in Childhood

Childhood Methanol Ingestion Treated With Fomepizole and Hemodialysis

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