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Liver, Renal, and Cardiovascular Failure After Unintentional Overdose of Tizanidine in a 2-Year-Old Child

Jorgina Vila, Andrés Morgenstern, Lourdes Vendrell

    The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
    |August 23, 2021
    PubMed

    Insights

    Tizanidine overdose in a child with spastic quadriplegia caused severe liver, kidney, and cardiovascular failure. This case highlights the risks of high-dose tizanidine in pediatric patients, especially with comorbidities and dehydration.

    Area of Science:

    • Pharmacology
    • Pediatric Critical Care
    • Toxicology

    Background:

    • Tizanidine, an alpha-2 adrenergic agonist, is approved for adult spasticity but used off-label in pediatrics.
    • Gradual dose titration is standard in adults; however, overdose risks in children are less understood.
    • Comorbidities like spastic quadriplegia and dysphagia can complicate pediatric treatment.

    Purpose of the Study:

    • To report a case of severe tizanidine overdose in a pediatric patient.
    • To highlight the potential for serious organ dysfunction following accidental high-dose tizanidine administration in children.
    • To emphasize the importance of careful dosing and monitoring in pediatric patients with spasticity.

    Main Methods:

    • Case report of a 2-year-old male with spastic quadriplegia and dysphagia.
    • Documented accidental overdose of tizanidine (1.6 mg/kg/day) after clonazepam withdrawal and nasogastric tube dislodgement.
    • Clinical presentation, laboratory findings (hepatic and renal dysfunction), and supportive treatment in the pediatric intensive care unit were analyzed.

    Main Results:

    • The patient presented with hemodynamic instability, altered consciousness, and severe dehydration.
    • Blood tests indicated significant hepatic and renal dysfunction.
    • Diagnosis was liver, renal, and cardiovascular failure secondary to tizanidine overdose, exacerbated by dehydration.

    Conclusions:

    • Tizanidine overdose can lead to critical organ failure in pediatric patients.
    • Dehydration and underlying comorbidities significantly worsen the outcomes of tizanidine overdose.
    • This case underscores the need for cautious tizanidine use and close monitoring in the pediatric population.

    Keywords:
    drug overdoseliver failure, acutemuscle spasticitytizanidinetoxicology

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