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Massive accidental overdose of hydroxyurea in a young child with sickle cell anemia

Scott T Miller1, Kathy Rey, Jin He

  • 1Division of Hematology/Oncology, SUNY-Downstate Medical Center/Kings County Hospital Center, Brooklyn, New York 11203, USA. scott.miller@downstate.edu

Pediatric Blood & Cancer
|July 12, 2011
PubMed

Insights

Hydroxyurea is safe and effective for infants with sickle cell anemia, reducing complications. Accidental overdose in a child showed only mild, temporary toxicity, suggesting conservative management is appropriate.

Area of Science:

  • Pediatric Hematology
  • Pharmacology
  • Clinical Toxicology

Background:

  • Sickle cell anemia (SCA) is a debilitating genetic blood disorder affecting infants.
  • Hydroxyurea therapy has demonstrated efficacy in managing SCA, but its safety profile in overdose requires further understanding.
  • The BABY HUG trial (NCT00006400) evaluated hydroxyurea's safety and efficacy in infants with SCA.

Observation:

  • A 2-year-old child accidentally ingested a 35-day supply of hydroxyurea (612 mg/kg).
  • Peak serum hydroxyurea levels reached 7,756 µM four hours post-ingestion.
  • The only observed adverse effect was transient, mild myelosuppression.

Findings:

  • Hydroxyurea treatment in infants with SCA significantly reduced pain episodes, acute chest syndrome, hospitalizations, and blood transfusions.
  • Hematologic values improved with hydroxyurea therapy.
  • The accidental massive overdose did not result in severe toxicity, indicating a potentially wide safety margin.

Implications:

  • The findings support the established safety and efficacy of hydroxyurea for infants with SCA.
  • Conservative management of accidental hydroxyurea overdoses in children appears to be a reasonable approach.
  • Wider clinical use of hydroxyurea in pediatric SCA management is anticipated, necessitating awareness of overdose management.

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