title: Accidental ten times overdose administration of recombinant human erythropoietin (rh-EPO) up to 318,000 units a day in acute myocardial infarction: report of two cases.
abstract: The cytokine erythropoietin protects the heart from ischaemic injury, in part by preventing apoptosis. But appropriate dose of erythropoietin for the protection of injured heart has not been studied. While we were researching the cardiac protective effects of erythropoietin in acute myocardial infarction, we experienced two cases of accidental nearly ten times overdose administration of erythropoietin up to 318,000 units instead of 33,000 units on the second day of three scheduled days of treatment. So a total of 384,000 units of erythropoietin were administered during three days. In case 1, the ALT level soared up to 386 U/l on the second day of administration and decreased slowly. It was back to normal state 3 months later. The AST level increased slowly up to 391 U/l and normalized 3 months later. Haemoglobin level was elevated up to 15.7 g/dl (14.7 g/dl at admission) and, 3 months later, normalized to 14.8 g/dl. In case 2, the ALT level was elevated up to 98 U/l on the second day of administration and decreased slowly. Three months later, the ALT level was normalized. The AST level also increased slowly up to 71 U/l and normalized 3 months later. Haemoglobin level was elevated up to 15.6 g/dl (13.8 g/dl at admission) and, 3 months later, normalized to 13.6 g/dl. In these two cases reported, these patients, even after massive overdose, tolerated it relatively well and the only side-effects we found were elevated liver enzyme and haemoglobin levels.
authors.affiliation: Cardiology Division, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Shin
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Kwon
authors.forename: Sung-Il
authors.initials: SI
authors.lastname: Choi
authors.forename: Ui-Soon
authors.initials: US
authors.lastname: Park
authors.forename: Je
authors.initials: J
authors.lastname: Lee
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Shin
authors.forename: Jae-Ung
authors.initials: JU
authors.lastname: Lee
authors.forename: Soon-Gil
authors.initials: SG
authors.lastname: Kim
authors.forename: Jeong-Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Heon-Kil
authors.initials: HK
authors.lastname: Lim
authors.forename: Bang-Hun
authors.initials: BH
authors.lastname: Lee
authors.forename: Kyung-Soo
authors.initials: KS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D062787:Drug Overdose; D004921:Erythropoietin / Q000009:adverse effects* / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000201:enzymology; D011994:Recombinant Proteins
chemical_list: D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase