An unusual mimicker of a sepsis outbreak: ergot intoxication

Abstract

Methylergonovine (MEV) is a semi-synthetic ergot alkaloid used in the prevention and control of postpartum hemorrhage. This report describes 12 newborns born on the same day in a local country hospital in Turkey and developed sepsis-like symptoms and encephalopathy within the first 6 h of life due to accidental administration of MEV instead of vitamin K in the delivery room. The major features of MEV poisoning were lethargy (41.7%), seizure (75.0%), feeding intolerance (66.6%), hypoventilation (58.3%), irritability (25%), and peripheral circulatory abnormalities (58.3%). As a conclusion, clinical findings of ergot toxicity in newborns cannot be distinguished from infectious disease or neonatal encephalopathy.

Inadvertent Methylergometrine Administration to a Neonate with Underline Acyanotic Congenital Heart Disease

“…Currently, Methylergometrine maleate (Methergine) MEM is the ergot most commonly used for post-partum uterine atony. Typical effect in newborn as a side effect includes respiratory depression or distress, cyanosis, pallor, hypertension, vasoconstriction, hypoxia, and feeding intolerance decreased capillary refill, oliguria, and seizures [7][8][9][10]. Respiratory depression is the most common and immediately lifethreatening manifestation, presenting in up to 55% of cases within six hours of intramuscular (IM) administration [2,9].…”

Inadvertent oral administration of methylergometrine maleate to children in the first months of life: from surveillance to prevention

“…With specific reference to methylergometrine maleate, the observations reported in the literature since early ′70s on life‐threatening therapeutic errors due to injection to newborn children of uterotonic ergot alkaloids instead of vitamin K or Naloxone provided clear indications about the necessity to avoid the administration of non‐urgent drugs to the neonate immediately after birth in the delivery room . Nevertheless new cases of such a type of incident continue to be reported …”

“…Accidental administration of this medicine to newborns can cause severe effects and should be carefully prevented. Since the early ′70s, cases of severe acute poisoning due to inadvertent injection in the delivery room of ergometrine or methylergometrine maleate in place of vitamin K or Naloxone have been reported . The victims of such an event usually develop encephalopathy, seizure, and peripheral vascular disturbances.…”

“…Since the early ′70s, cases of severe acute poisoning due to inadvertent injection in the delivery room of ergometrine or methylergometrine maleate in place of vitamin K or Naloxone have been reported. [2][3][4][5][6][7][8][9][10] The victims of such an event usually develop encephalopathy, seizure, and peripheral vascular disturbances. Most of them require ventilatory support.…”

“…5 When properly treated, the acute symptomatology tends to resolve within 4 days, and the newborn recovery is complete within a week. 5,8 Cases of poisoning due to inadvertent oral administration of methylergometrine maleate in the first weeks of life have been reported in a few studies: an Italian case-report describing an 8-day-old baby who received orally 0.06 mg/kg of methylergometrine maleate and developed vomiting, diarrhoea, and hypertension; 11 a review of 34 cases of exposure to methylergometrine maleate handled by the National Poison Control Centre of Belgium in 1969-1999, highlighting that oral doses between 0.02 and 0.35 mg/kg administered to children aged <1 month can cause toxic effects of minor or moderate severity including vomiting, tachycardia, vasoconstriction, and diarrhoea. Most of the reviewed cases occurred at home and were due to mix-up of the gynaecological medicine with paediatric multivitamins.…”