Sildenafil citrate ingestion and prolonged priapism and tachycardia in a pediatric patient

Abstract

Introduction.Little is known about the toxicity of sildenafil overdose in the pediatric population. We present a case of prolonged priapism and tachycardia due to unintentional sildenafil overdose in a child. Case report. A 19-month-old male ingested up to six 50 mg Viagra tablets 45 minutes prior to presentation at the emergency department. Initial vital signs included temperature 98.2 o F, blood pressure 90/58 mmHg, heart rate 140, respirations 20, and oxygen saturation of 100% on room air. The child weighed 10.4 kg. Physical exam revealed a happy, smiling, laughing toddler who was cooperative with all aspects of his exam. He had mild facial flushing and an erect penis which was normal in color and had a capillary refill of two seconds. Precordial palpation did not show evidence of increase dynamic force, his heart sounds were regular, and no ectopy was noted. His peripheral pulses were strong and regular in all four extremities. No gastrointestinal decontamination was performed. The patient was started on maintenance IV fluids and admitted to the pediatric floor for observation. The patient had a non-painful tumescent penis and mild tachycardia for about 24 hours post-ingestion. The child never had pain from the constant erection. Sildenafil concentration drawn approximately seven hours after ingestion was 3900 ng/ml (reporting limit 24 ng/ml) and N-desmethylsildenafil level was 1700 ng/ml (reporting limit 24 ng/ml). Conclusion. This case of pediatric sildenafil ingestion (up to 30mg/kg) initially resulted in facial flushing and priapism. The child had asymptomatic tachycardia and prolonged priapism that persisted until hospital discharge approximately 24 hours after ingestion. The erection was non-painful and required no urologic intervention, most likely representing a high flow state. In this ingestion, only supportive care was required.

Idiopathic high-flow priapism in a pediatric patient

“…There have been a very few cases of pediatric high-flow priapism related to sicklecell anemia, leukemia, Fabry's disease, or sildenafil toxicity [2]. There is only one case report of high-flow priapism of unknown etiology in a child in the literature [1].…”

Resistant pediatric priapism: A real challenge for the urologist

“…These issues were not true in our patient. 21,22 However, we discovered that our patient had a traumatic incident a week before the initial presentation, which revealed the importance of traumatic events in the cause of priapism.…”

Blue Vision and Sinus Tachycardia: Sildenafil Citrate Overdose

“…The main common side effects according to this report are skin rash, vertigo, headache, tachycardia, chest pain, and dizziness (5). Prolonged priapism and tachycardia after an overdose of approximately 300 mg of SC in the case of a 19-month-old baby boy and spontaneous intracerebral hemorrhage in another case are other reported cases related to SC overdose in literature (2,6).…”

“…Sildenafil citrate (SC), which acts by inhibiting the phosphodiesterase type 5 enzyme (PDE 5 ), is used as a drug for the treatment of erectile dysfunction (ED) and pulmonary arterial hypertension (PAH) these days (1,2). Literature has very limited data related to overdose of SC.…”