A Very Bad Hair Day: Minoxidil Ingestion Causing Shock and Heart Failure

Minoxidil is a potent directly acting vasodilator previously used in treatment-resistant hypertension. It possesses several serious side effects including fluid retention, worsening of heart failure, reflex tachycardia, angina, myocardial infarction, pericardial effusion, and hypotension. It is currently reserved for treating alopecia and readily available over the counter as a topical formulation. Intentional/accidental ingestion of topical minoxidil can cause refractory circulatory shock requiring aggressive hydration and vasopressor support. We present a case of a young female with unintentional ingestion of minoxidil leading to severe circulatory shock and acute pulmonary edema. Minoxidil, a common hair loss treatment, is highly dangerous if ingested. Immediate identification and treatment are crucial, involving fluid resuscitation and vasopressors for severe circulatory shock. Midodrine, an alpha-adrenergic agonist, can reduce ICU stay by shortening IV vasopressor usage.