A fatal overdose of arginine hydrochloride.
Arginine hydrochloride is used both diagnostically to test for growth hormone deficiency and therapeutically for treatment of metabolic alkalosis. We describe a 21-month-old girl who developed cardiopulmonary arrest following an accidental overdose of arginine hydrochloride. The patient developed acute metabolic acidosis and transient, but severe, hyponatremia. Thirty-six hours after successful resuscitation, she developed fatal central pontine and extrapontine myelinolysis. Unlike previous reports of arginine-toxicity, our patient showed no evidence of hyperkalemia. This case illustrates a previously unreported mechanism of arginine hydrochloride toxicity.
Gerard
J M
JM
St. Louis University, School of Medicine, St. Louis University Health Sciences Center, Missouri, USA.
Luisiri
A
A
D000138:Acidosis / Q000139:chemically induced; D001120:Arginine / Q000506:poisoning*; D002531:Cerebellum / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D062787:Drug Overdose; D017809:Fatal Outcome; D005260:Female; D006130:Growth Disorders / Q000175:diagnosis; D013006:Growth Hormone / Q000172:deficiency; D006323:Heart Arrest / Q000139:chemically induced; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced; D007223:Infant; D008508:Medication Errors; D017590:Myelinolysis, Central Pontine / Q000139:chemically induced* / Q000000981:diagnostic imaging; D011149:Pons / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D014057:Tomography, X-Ray Computed
D013006:Growth Hormone; D001120:Arginine