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Mexiletine overdose producing status epilepticus without cardiovascular abnormalities
1New York City Poison Center, New York 10016.
Journal of Toxicology. Clinical Toxicology
|January 1, 1994
Summary
Mexiletine overdose can cause seizures, even without heart abnormalities. This case highlights the potential for central nervous system toxicity from high mexiletine levels.
Area of Science:
- Cardiology
- Neurology
- Clinical Toxicology
Background:
- Mexiletine is an antiarrhythmic drug similar to lidocaine.
- Reported mexiletine overdoses typically involve cardiovascular complications.
- Limited data exists on severe mexiletine toxicity without hemodynamic compromise.
Observation:
- A patient ingested a large quantity of mexiletine (up to 90 x 200 mg tablets).
- She presented with normal vital signs and electrocardiogram (ECG).
- The patient developed generalized motor seizures and status epilepticus, requiring aggressive treatment.
Findings:
- The patient's mexiletine level was significantly elevated (20 mcg/mL, therapeutic range 1-2 mcg/mL).
- Despite the high level and seizures, hemodynamic and ECG parameters remained normal.
- Treatment included diazepam, phenobarbital, and pyridoxine for status epilepticus.
Implications:
- Mexiletine overdose can manifest primarily as central nervous system toxicity (seizures) without typical cardiovascular effects.
- Physicians should consider CNS toxicity in mexiletine overdose cases, even with normal ECGs.
- This case expands the understanding of mexiletine's toxicity profile, emphasizing potential neurological manifestations.