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Case report: acute unintentional carbachol intoxication.
Martin Schulz1, Thomas Graefe, Klaus Stuby
1Department of Pharmacology, University of Frankfurt, and Head, Center for Drug Information and Pharmacy Practice, ABDA-Federal Union of German Associations of Pharmacists, Jaegerstrasse 49/50, 10117 Berlin, Germany. Schulz@em.uni-frankfurt.de
Critical Care (London, England)
|June 3, 2006
Summary
A rare carbachol poisoning case highlights the dangers of self-medication based on media reports. High carbachol serum concentrations were detected, leading to severe cholinergic symptoms and eventual death, emphasizing the need for caution with potent substances.
Area of Science:
- Toxicology
- Pharmacology
- Clinical Medicine
Background:
- Carbachol, a muscarinic cholinergic receptor agonist, is rarely associated with intoxications.
- This case investigates a near-fatal poisoning resulting from self-administration of carbachol.
- The patient's son was influenced by a newspaper report on plant extracts for Alzheimer's disease, mistaking carbachol's action.
Observation:
- The 84-year-old patient ingested 400-500 mg of pure carbachol.
- Immediate symptoms included nausea, sweating, hypotension, bradycardia, and asystole.
- Intensive care was required, including high doses of atropine, adrenaline, and dopamine, with complications like respiratory insufficiency and infection.
Findings:
- Serum carbachol concentrations on hospital admission were 3.6 mg/l (day 1) and 1.9 mg/l (day 2).
- Urine carbachol concentrations were significantly higher: 374 mg/l (day 1) and 554 mg/l (day 2).
- Measured carbachol levels were 130-260 times higher than expected for a therapeutic dose.
Implications:
- This case underscores the critical need for medical expertise in interpreting and applying research findings, especially those reported in popular media.
- The development of an analytical method for carbachol determination in biological samples is a significant contribution.
- Clinicians, particularly intensivists, should consider cholinergic toxicity in elderly patients presenting with acute cardiovascular failure.