The First Use of Pralidoxime in a Child With Rivastigmine Poisoning.
The aim of this report is to describe the successful use of pralidoxime in a pediatric patient who accidentally ingested 12 mg of rivastigmine and presented to the emergency department with weakness, drowsiness, hyporeactivity to environmental stimuli, and full cholinergic syndrome.


METHODS
The patient presented to the emergency department 2 hours after a suspected ingestion of rivastigmine. He was sleepy but oriented and cooperative, hypotonic, and hyporeflexic and has a Glasgow Coma Scale score of 13 (E3M6V4). Laboratory tests showed a low plasma cholinesterase levels of 2141 U/L (reference range, 5300-12 900 U/L), hyperglycemia (251 mg/dL), and leukocytosis with neutrophilia (21 900/mL, 75.2% neutrophils).


CONCLUSIONS
Only 2 pediatric cases of rivastigmine poisoning have been reported in the literature, and there are no previous reports of using pralidoxime in the management of this poisoning. In the present case, intravenous pralidoxime (30 mg/kg) was administered twice at the fifth and sixth hours of ingestion for nicotinic and central effects. There is reasonable theoretical science to suggest pralidoxime in case of acetylcholinesterase inhibitor toxicity. We conclude that observed clinical improvement in weakness temporally associated with pralidoxime administration. Increased plasma cholinesterase activity after pralidoxime administration also makes it useful in this type of poisoning.
From the Divisions of Emergency Medicine and.
Eylem Ulaş
EU
Saz
From the Divisions of Emergency Medicine and.
Ali
A
Yurtseven
Critical Care, Department of Pediatrics, Ege University School of Medicine.
Mehmet Arda
MA
Kilinç
Critical Care Units, Dr Behçet Uz Children's Hospital, Izmir, Turkey.
Ferhat
F
Sari
Critical Care Units, Dr Behçet Uz Children's Hospital, Izmir, Turkey.
Hasan
H
Ağin
D002675:Child, Preschool; D002800:Cholinesterase Inhibitors / Q000506:poisoning*; D002801:Cholinesterase Reactivators / Q000627:therapeutic use*; D002802:Cholinesterases / Q000097:blood; D006801:Humans; D008297:Male; D011220:Pralidoxime Compounds / Q000627:therapeutic use*; D000068836:Rivastigmine / Q000506:poisoning*
D002800:Cholinesterase Inhibitors; D002801:Cholinesterase Reactivators; D011220:Pralidoxime Compounds; D002802:Cholinesterases; C028797:pralidoxime; D000068836:Rivastigmine