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Amphotericin B overdose in pediatric patients with associated cardiac arrest
J D Cleary1, J Hayman, J Sherwood
1School of Pharmacy, University of Mississippi, Jackson 39216.
Insights
Amphotericin B overdose in children can cause fatal cardiac arrest. Hydrocortisone may reduce mortality from cardiac arrhythmias in pediatric overdose cases, warranting further study.
Area of Science:
- Pediatric Cardiology
- Clinical Toxicology
- Pharmacology
Background:
- Amphotericin B is a critical antifungal medication used in pediatric care.
- Overdose cases are rare, and their cardiac implications in children are not well-documented.
Observation:
- Five pediatric patients experienced cardiac complications, including cardiac arrest, following amphotericin B overdose (4.6–40.8 mg/kg/d).
- Four out of five patients died; one survivor received hydrocortisone prophylaxis and verapamil therapy.
- Cardiac events in humans resemble those observed in canine studies at similar overdose levels.
Findings:
- High-dose amphotericin B can lead to severe, potentially fatal cardiac events in pediatric patients.
- Hydrocortisone prophylaxis showed promise in preventing cardiac arrhythmias in the sole survivor.
Implications:
- Amphotericin B overdose poses a significant risk to pediatric patients, necessitating careful dosing and monitoring.
- Hydrocortisone may be a viable intervention to mitigate cardiac toxicity from amphotericin B overdose.
- Further animal studies are recommended to validate hydrocortisone's efficacy and safety in this context.
Objective:
To report the first five cases of amphotericin B overdose with secondary cardiac complications in a pediatric population. Treatment is also presented.
Setting:
Hospital.
Patients:
Two infants and three children inpatients receiving amphotericin B.
Interventions And Results:
Cardiac complications were observed in five pediatric patients who received between 4.6 and 40.8 mg/kg/d of amphotericin B. Cardiac arrest occurred in all patients, and four patients died. A detailed description of the cardiac event is provided for one patient who was on a cardiac monitor during the adverse reaction. Hydrocortisone prophylaxis and verapamil therapy were the primary therapies used in patient 1 (the only survivor). Evaluation of the literature provides substantial evidence for the use of hydrocortisone in prevention of cardiac arrhythmias.
Conclusions:
Amphotericin B overdose can be fatal in children and infants. The presentation in humans appears similar to that in dogs where cardiac arrhythmias occurred at doses of 5-15 mg/kg. Hydrocortisone may decrease the incidence of mortality associated with cardiac arrhythmias in children receiving amphotericin B overdoses. Animal studies are necessary to evaluate this observation and potential disadvantages of hydrocortisone usage.