Tretinoin overdose: a first case report.
BACKGROUND
Tretinoin (Vesanoid) is an all-trans-retinoic acid, and is related to retinol (Vitamin A). To date, there have been several case reports on overdose with its isomer isotretinoin, but none involving overdose of tretinoin. We report the first known case of a patient who ingested a massive overdose of tretinoin.


METHODS
A 31-year-old man ingested 1000 mg of tretinoin (100 pills of Vesanoid 10 mg) in a suicide attempt. He developed nonbloody diarrhea, but otherwise had no complaints. Clinical examination was normal. The patient was treated with activated charcoal and was hydrated. The patient's blood results did not show any deterioration on the third consecutive day. He was discharged well on the third day, but was subsequently lost to follow-up.


CONCLUSIONS
Although there has been no reported experience with acute tretinoin overdose in humans, our patient took a dose approximately 3 times the recommended maximum tolerated daily dose in patients with myelodysplastic syndrome or solid tumors (195 mg/m2 per day). Overdose with other retinoids such as isotretinoin have been associated with only minor symptoms that resolved quickly. Our patient had diarrhea, which also resolved quickly with symptomatic treatment and hydration.


CONCLUSIONS
We believe this to be the first case report of an acute oral overdose of tretinoin. The patient developed diarrhea, but was otherwise asymptomatic.
Department of Emergency Medicine, Singapore General Hospital, Singapore. angosy@gmail.com
Adeline
A
Su-Yin
Joyce
J
Wong
Timothy
T
Wiegand
Kent
K
Olson
D000328:Adult; D000970:Antineoplastic Agents / Q000506:poisoning*; D002606:Charcoal / Q000627:therapeutic use; D003967:Diarrhea / Q000139:chemically induced / Q000503:physiopathology / Q000628:therapy; D062787:Drug Overdose / Q000628:therapy; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D013406:Suicide, Attempted; D016896:Treatment Outcome; D014212:Tretinoin / Q000506:poisoning*
D000970:Antineoplastic Agents; D002606:Charcoal; D014212:Tretinoin