title: Acute pulmonary edema associated with naphazoline ingestion.
abstract: In published reports of naphazoline ingestion, clinical effects are hypertension, bradycardia, pallor, diaphoresis, and respiratory distress. We report three cases of acute pulmonary edema after the intentional ingestion of naphazoline-containing antiseptic first aid liquid. These cases presented with altered mental status, hypertension, bradycardia, and diaphoresis. Chest x-ray on admission revealed acute pulmonary edema. Two cases required mechanical ventilation. All of these clinical effects resolved within 24 hours and the patients were discharged with no sequelae. Since naphazoline stimulates the peripheral alpha-2 adrenergic receptor, we speculate that intense vasoconstriction may have elevated cardiac afterload and left atrial-ventricular blood volume and caused acute pulmonary edema.
authors.affiliation: Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijou cho, Kashihara City, Japan. hidetada@naramed-u.ac.jp
authors.forename: Hidetada
authors.initials: H
authors.lastname: Fukushima
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Norimoto
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Seki
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishiguchi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakamura
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Konobu
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishio
authors.forename: Kazuo
authors.initials: K
authors.lastname: Okuchi
mesh_terms: D000328:Adult; D001919:Bradycardia / Q000139:chemically induced; D003863:Depression / Q000150:complications / Q000523:psychology; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009278:Naphazoline / Q000008:administration & dosage / Q000506:poisoning*; D014663:Nasal Decongestants / Q000008:administration & dosage / Q000506:poisoning*; D011605:Psychoses, Substance-Induced / Q000523:psychology; D011654:Pulmonary Edema / Q000139:chemically induced* / Q000000981:diagnostic imaging; D011859:Radiography; D013406:Suicide, Attempted
chemical_list: D014663:Nasal Decongestants; D009278:Naphazoline