Intoxicación grave con nafazolina: puesta al día a partir de un error terapéutico

Abstract

Naphazoline is a drug commonly used as a decongestant in adult patients. Its indication in Pediatrics is not frequent, being approved its use from the age of 12 for the toxic effects it possesses. Intoxication in children generates a potentially serious clinical picture. It is characterized by the immediate appearance of hypotonia, deterioration of the sensory, hypothermia and bradycardia of variable degree of clinical compromise. Although it is an infrequent intoxication, the anamnesis and the initial management of the patient are the key in the evolution. We present a 4-year-old boy who, as a therapeutic error, receives this drug, emphasizing the rapid and potentially severe establishment of the clinical picture.

Pathogenetic features of acute naphazoline poisoning in children

“…Depression of the central nervous system (alteration of consciousness progressing to coma) occurred in case of an accidental ingestion of the drug (swallowing) or a one-time instillation of a large dose of naphazoline (Taylor and Maslov 2013;Lowry and Brown 2014). As reported by most studies, this effect is especially prominent in early childhood (Senin and Morozov 2012;Kalashnikova and Chelpachenko 2013;Taylor and Maslov 2013;Lowry and Brown 2014;Díaz et al 2018;Pshenichnaya et al 2018;Petukhova et al 2019;Shilov et al 2019;Tulupov et al 2018;Euwema and Swanson 2020).…”

“…Most often the poisoning occurred when drugs with naphazoline as the main active ingredient were used (up to 86.8% of all the poisonings by drugs of this group) (Tulupov et al 2018;Petukhova et al 2019;Shilov et al 2019). According to the foreign studies in several countries, such as Croatia, Belgium and France, cases of acute poisoning by naphazoline were noted both after its normal therapeutic usage and due to overdose (Taylor and Maslov 2013;Lowry and Brown 2014;Díaz et al 2018;Euwema and Swanson 2020). Depression of the central nervous system (alteration of consciousness progressing to coma) occurred in case of an accidental ingestion of the drug (swallowing) or a one-time instillation of a large dose of naphazoline (Taylor and Maslov 2013;Lowry and Brown 2014).…”

“…Some cases of severe naphazoline poisoning after its intranasal administration were also reported. Thus, a 18-month-old baby rapidly developed profound CNS depression accompanied by bradycardia, hypothermia, and hypoventilation after use of naphazoline in rhinopharyngitis treatment (Díaz et al 2018). A one-month-old girl was admitted to hospital in coma with skin pallor, hypothermia, hypotension, bradycardia, and apnea after naphazoline instillation (Euwema and Swanson 2020).…”

“…In addition, an increase in the number of thrombocytes can be a risk factor for development of thrombotic complications. Electrocardiograms of the patients with poisoning showed heart rhythm disturbance and cardiac conduction failure (Kalashnikova and Chelpachenko 2013;Díaz et al 2018).…”