Acute buflomedil intoxication: a life-threatening condition.
A 15-year-old girl was admitted to ICU in a comatose state. She presented with mydriasis, areflexia, hypoxemia and seizures. She was immediately intubated and connected to a ventilator. The seizures were reversed with intravenous diazepam. CT scan was negative. EEG showed a diffuse fast activity and theta waves with spikes in the anterior and temporal regions, bilaterally. The gastric lavage was suggestive of drug ingestion. The patient completely recovered after 6 h of mechanical ventilation and supportive management. Mydriasis was still present after the resolution of neurological symptoms. The girl told us she had ingested 10 tablets (3 g-55 mg/kg) of Loftyl (buflomedil) for suicidal intention. The buflomedil concentrations at 2-3 h from ingestion were 24.8 mg/l in the blood, 324.4 mg/l in the urine and 6.9 mg/l in the gastric content. The p-desmethyl metabolite was also identified in the urine. Buflomedil is a rheological agent largely used as a vasodilator in some European countries. Some recent reports have emphasized the risk of acute intoxication with this drug. Relatively low doses (50-60 mg/kg) have been associated with an important neurological toxicity and a high mortality. We suggest that the clinical picture we observed might be related to a neuroleptic-type action of buflomedil. We bring to attention the risk of a large, uncontrolled diffusion of a drug capable to cause serious consequences at relatively low doses.
Unità di Terapia Intensiva Ospedale Dolo, Venezia.
A
A
Alberti
S
S
Valenti
F
F
Gallo
M
M
Petolillo
D
D
Del Monte
D000208:Acute Disease; D000293:Adolescent; D003131:Combined Modality Therapy; D003975:Diazepam / Q000627:therapeutic use; D004569:Electroencephalography; D017809:Fatal Outcome; D005260:Female; D005751:Gastric Lavage; D006801:Humans; D000860:Hypoxia / Q000139:chemically induced; D007362:Intensive Care Units; D015878:Mydriasis / Q000139:chemically induced; D011041:Poisoning / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D011759:Pyrrolidines / Q000097:blood / Q000737:chemistry / Q000506:poisoning*; D012121:Respiration, Artificial; D012640:Seizures / Q000139:chemically induced / Q000188:drug therapy; D013406:Suicide, Attempted; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents / Q000097:blood / Q000737:chemistry / Q000506:poisoning*
D011759:Pyrrolidines; D014665:Vasodilator Agents; D003975:Diazepam; C010651:buflomedil