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Nifedipine poisoning in a child
T G Wells1, C J Graham, M M Moss
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock.
Insights
A massive nifedipine overdose in an infant caused cardiac arrest, seizures, and blindness. Prompt medical intervention and resuscitation led to a full recovery without lasting effects.
Area of Science:
- Cardiology
- Pediatric Toxicology
- Neurology
Background:
- Nifedipine is a calcium channel blocker used to treat hypertension and angina.
- Infant overdose of nifedipine is rare but can be life-threatening.
Observation:
- A 14-month-old child ingested a large dose of nifedipine, presenting with unresponsiveness, severe hypotension, and hyperglycemia.
- Electrocardiogram revealed third-degree atrioventricular block progressing to cardiac arrest.
Findings:
- Cardiopulmonary resuscitation, mechanical ventilation, and intravenous fluids (normal saline, calcium chloride, dopamine) were necessary for resuscitation.
- Complications included pulmonary edema, cerebral infarction leading to cortical blindness, and seizures with abnormal electroencephalogram.
- The child recovered fully without apparent long-term sequelae.
Implications:
- Massive nifedipine overdose in infants is a critical medical emergency requiring immediate and aggressive management.
- This case highlights the severe cardiotoxic and neurotoxic effects of nifedipine in young children.
- Prompt recognition and intervention are crucial for favorable outcomes in pediatric nifedipine intoxication.
Abstract:
A 14-month-old child ingested approximately 800 mg (70 mg/kg) of nifedipine. When first examined, the child was unresponsive, markedly hypotensive, and hyperglycemic. According to electrocardiographic results, there was a third-degree atrioventricular block that rapidly progressed to cardiac arrest. Following successful cardiopulmonary resuscitation, mechanical ventilation and resuscitation with intravenous normal saline, calcium chloride and dopamine were required to restore perfusion, reverse metabolic acidosis, and stabilize vital signs. Complications related to nifedipine intoxication included the development of pulmonary edema and possible infarction in the posterior parietal and occipital lobes associated with cortical blindness and the development of seizures with an abnormal electroencephalogram. The patient recovered without clinically apparent residua. Massive nifedipine overdose in infants represents a potentially life-threatening event that requires prompt medical attention. Reported cases of nifedipine intoxication were reviewed and therapeutic interventions were discussed.