title: Ephedrine-induced cardiac ischemia: exposure confirmed with a serum level.
abstract: The temporal association of symptoms consistent with ephedrine toxicity after ingestion of ephedrine-containing dietary supplements is heavily relied upon to confirm exposure. Few reports in the literature attempt to associate toxicity with serum levels of these drugs. We report a case of ephedrine-induced cardiac ischemia confirmed by a plasma level. A 22-year-old woman ingesting an ephedrine- and caffeine-containing product for 2 days presented with multiple symptoms, including palpitations, nausea, tremulousness, abdominal pain, and vomiting. The initial electrocardiogram (ECG) revealed a normal sinus rhythm with 1 mm of ST segment depression in leads V3 and V4, along with inverted T waves in leads V1-V4. Her symptoms and ST segment depression resolved over several hours with medical management. The amplitude of her T wave inversions notably diminished with therapy; however, they did not completely resolve. Troponins at presentation and the following morning were negative, and an echocardiogram showed only trace tricuspid regurgitation. A serum ephedrine level, drawn approximately 6 to 7 hr after ingestion, was 150 ng/mL. She was discharged from the hospital after being instructed to avoid ephedrine-containing products.
authors.affiliation: NYC Poison Control Center, New York, New York, USA. jschier@pol.net
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Schier
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Traub
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Nelson
mesh_terms: D000328:Adult; D004452:Echocardiography; D004562:Electrocardiography / Q000187:drug effects; D004809:Ephedrine / Q000097:blood / Q000633:toxicity*; D005260:Female; D006801:Humans; D017202:Myocardial Ischemia / Q000097:blood / Q000139:chemically induced*; D014336:Troponin / Q000097:blood; D014662:Vasoconstrictor Agents / Q000097:blood / Q000633:toxicity*
chemical_list: D014336:Troponin; D014662:Vasoconstrictor Agents; D004809:Ephedrine