Mixed propranolol and tizanidine overdose treated with intravenous lipid emulsion

Souza, Rhadika; Jauregui, Joshua; Valento, Matthew

doi:10.1080/24734306.2018.1522027

Cited by 2 publications

(1 citation statement)

References 17 publications

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“…Hypokalemia attributed to tizanidine use has also been described and is listed on the prescribing information as a rare adverse event when taken as directed and not in total daily doses exceeding 24 mg [ 4 ], although information on severe cases in the literature is sparse [ 5 , 6 ]. Once ingested, 60% of tizanidine is eliminated by the kidneys, and in those with a renal impairment (such as our patient), it is expected that exposure to the drug increases.…”

Section: Discussionmentioning

confidence: 99%

Potassium wasting nephropathy in the setting of tizanidine overdose: a case report

Brucculeri

García

2021

J Med Case Reports

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Background Hypokalemia has been rarely attributed to tizanidine, although the precise mechanism is unclear. Severe hypokalemia is a well-established cause of abnormalities involving cardiac conduction. Given this agent’s well-known cardiac arrhythmogenic potential, awareness of potential concomitant electrolyte abnormalities is important. Case presentation Electrolyte disorders, including hypokalemia, are rare complications of the antispasmodic medicine tizanidine when taken in doses as outlined by the manufacturer’s prescribing instructions. Although cases of severe hypokalemia have also been described in the literature in association with this agent, such reports are few. We report a Caucasian case of an intentional overdose involving a very large ingestion of tizanidine. In addition to the characteristic abnormalities on the electrocardiogram, our patient developed electrolyte derangements as well as self-limited acute kidney injury. These biochemical abnormalities included profound hypokalemia that was refractory to aggressive replacement over the ensuing several days, before eventually dissipating. A thorough assessment of the etiology of this hypokalemia was consistent with a defect in renal potassium handling. Conclusion In our patient with intentional tizanidine overdose, severe and refractory hypokalemia appears to have been due to a transient potassium wasting nephropathy.

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Section: Discussionmentioning

confidence: 99%