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Cholinergic crisis caused by ingesting topical carpronium chloride solution: A case report
Takayuki Endo1, Shunsuke Amagasa2, Masahiro Kashiura3
1Department of Pharmacy, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Saitama-shi, Saitama 330-8503, Japan.
The American Journal of Emergency Medicine
|May 25, 2021
Summary
Ingesting carpronium chloride solution can cause a cholinergic crisis, a serious condition of excess acetylcholine. Physicians should be aware of this risk, even with topical formulations, as seen in a case of alopecia treatment overdose.
Area of Science:
- Toxicology
- Pharmacology
- Emergency Medicine
Background:
- A cholinergic crisis is a medical emergency caused by excess acetylcholine.
- Carpronium chloride is a topical medication used for alopecia, seborrhea sicca, and vitiligo.
- Ingestion of carpronium chloride is not a commonly reported cause of toxicity.
Observation:
- An 81-year-old woman ingested 4500 mg of carpronium chloride solution.
- The patient presented with altered consciousness, hypotension (80/40 mmHg), and bradycardia (40 bpm).
- Symptoms included excessive salivation, sweating, and flushing, consistent with a cholinergic crisis.
Findings:
- The patient's condition stabilized within 24 hours without specific antidotes or vasopressors.
- Gastric lavage was performed 78 minutes after ingestion.
- The patient recovered fully and was discharged without psychiatric concerns.
Implications:
- This case highlights carpronium chloride as a potential cause of cholinergic crisis following ingestion.
- Physicians should consider carpronium chloride toxicity in patients presenting with cholinergic symptoms after ingesting the topical solution.
- Further research into the pharmacokinetics and toxicity of ingested carpronium chloride is warranted.
