title: Xylometazoline poisoning: A 40-fold nasal overdose caused by a compounding error in 3 children.
abstract: The imidazoline derivative xylometazoline, an alpha-2-adrenergic agonist, is used as non-prescription nasal preparation due to its vasoconstrictive and decongestive properties. Especially in children, an overdose can quickly cause severe central nervous system depression and cardiovascular adverse effects. In three 3-year-old boys (triplets) a xylometazoline intoxication was diagnosed by toxicological analysis. On admission to an emergency unit all three children were still unresponsive. One triplet showed respiration of 15-20 breaths/min and required oxygen support (3L/min) via face mask; his electrocardiogram revealed sinus bradycardia of 64 beats/min with supraventricular extrasystoles. However, no interventions were necessary except fluid management via intravenous lines. Eleven hours after the event, two of the triplets were awake but still not fully oriented. The third triplet woke up 20h after instillation of nose drops. Intoxication was caused by a compounding error in a pharmacy resulting in a concentration 40 times above the adequate dosage for children. In general, physicians, pharmacists and the public should be educated about the toxicity of over-the-counter preparations.
authors.affiliation: University Hospital, Institute of Forensic Medicine, Stiftsplatz 12, 53111 Bonn, Germany. Electronic address: f.musshoff@ftc-muenchen.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Musshoff
authors.affiliation: University Hospital, Institute of Forensic Medicine, Stiftsplatz 12, 53111 Bonn, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Madea
authors.affiliation: University Children's Hospital, Pediatric Endocrinology Division, Adenauerallee 119, Bonn 53113, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Woelfle
authors.affiliation: University Children's Hospital, Pediatric Endocrinology Division, Adenauerallee 119, Bonn 53113, Germany.
authors.forename: Dejan
authors.initials: D
authors.lastname: Vlanic
mesh_terms: D002675:Child, Preschool; D062787:Drug Overdose; D006801:Humans; D007093:Imidazoles / Q000506:poisoning* / Q000652:urine; D008297:Male; D008508:Medication Errors; D014663:Nasal Decongestants / Q000506:poisoning* / Q000652:urine; D014310:Triplets
chemical_list: D007093:Imidazoles; D014663:Nasal Decongestants; C009695:xylometazoline
keywords: Children; Compounding error; Intoxication; Xylometazoline