Dyskinesia due to mexiletine overdose: a rare presentation
Background. Mexiletine, a class IB antiarrhythmic, is a structural analog of lidocaine. Our knowledge of mexiletine overdose is based on lidocaine overdose reports. Only a few cases of mexiletine overdose have been reported, including fatal overdoses. Mexiletine toxicity primarily affects the...
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Hacettepe University Institute of Child Health
2023-08-01
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| Series: | The Turkish Journal of Pediatrics |
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| Online Access: | https://turkjpediatr.org/article/view/80 |
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| author | Zeynelabidin Öztürk Orkun Aydın İlknur Bodur Raziye Merve Yaradılmış Hale Atalay Çelik Nilden Tuygun |
| author_facet | Zeynelabidin Öztürk Orkun Aydın İlknur Bodur Raziye Merve Yaradılmış Hale Atalay Çelik Nilden Tuygun |
| author_sort | Zeynelabidin Öztürk |
| collection | DOAJ |
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Background. Mexiletine, a class IB antiarrhythmic, is a structural analog of lidocaine. Our knowledge of mexiletine overdose is based on lidocaine overdose reports. Only a few cases of mexiletine overdose have been reported, including fatal overdoses. Mexiletine toxicity primarily affects the central nervous, cardiovascular, and gastrointestinal systems.
Case. A 16-year-old female was brought to our hospital by ambulance after taking an unknown dose of mexiletine in a suicide attempt. Ventricular fibrillation developed while in the ambulance; cardiopulmonary resuscitation was started and spontaneous circulation returned within 1 min. The patient had been taking oral mexiletine for 1 month to treat primary erythromelalgia. Her vital signs were normal, but she was unconscious. Following gastric lavage she was transferred to the pediatric intensive care unit. Midazolam and levetiracetam were required due to uncontrolled seizures. During the first hour of hospitalization, severe dyskinesia characterized by abnormal involuntary large hyperkinetic movements in all 4 extremities was observed and successfully treated with 2 doses of intravenous biperiden. The patient was discharged on day 6 of hospitalization.
Conclusions. Mexiletine overdose can be life-threatening. In addition to rapid and effective resuscitation, rapid identification and management of cardiovascular and central nervous system manifestations are key to preventing morbidity and mortality. The presented case had severe dyskinesia that was successfully treated with repeated doses of biperiden. Biperiden did not cause arrhythmia. Based on the presented case, we think biperiden should be considered for the treatment of movement disorders in cases of mexiletine overdose.
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| format | Article |
| id | doaj-art-5739db389b3f4889af84eb3b0dd8520e |
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| issn | 0041-4301 2791-6421 |
| language | English |
| publishDate | 2023-08-01 |
| publisher | Hacettepe University Institute of Child Health |
| record_format | Article |
| series | The Turkish Journal of Pediatrics |
| spelling | doaj-art-5739db389b3f4889af84eb3b0dd8520e2025-08-20T02:17:53ZengHacettepe University Institute of Child HealthThe Turkish Journal of Pediatrics0041-43012791-64212023-08-0165410.24953/turkjped.2023.84Dyskinesia due to mexiletine overdose: a rare presentationZeynelabidin Öztürk0Orkun Aydın1İlknur Bodur2Raziye Merve Yaradılmış3Hale Atalay Çelik4Nilden Tuygun5Department of Pediatric Intensive Care, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara.Department of Pediatric Emergency Medicine, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara.Department of Pediatric Emergency Medicine, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara.Department of Pediatric Emergency Medicine, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara.Department of Pediatric Neurology, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Türkiye.Department of Pediatric Emergency Medicine, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara. Background. Mexiletine, a class IB antiarrhythmic, is a structural analog of lidocaine. Our knowledge of mexiletine overdose is based on lidocaine overdose reports. Only a few cases of mexiletine overdose have been reported, including fatal overdoses. Mexiletine toxicity primarily affects the central nervous, cardiovascular, and gastrointestinal systems. Case. A 16-year-old female was brought to our hospital by ambulance after taking an unknown dose of mexiletine in a suicide attempt. Ventricular fibrillation developed while in the ambulance; cardiopulmonary resuscitation was started and spontaneous circulation returned within 1 min. The patient had been taking oral mexiletine for 1 month to treat primary erythromelalgia. Her vital signs were normal, but she was unconscious. Following gastric lavage she was transferred to the pediatric intensive care unit. Midazolam and levetiracetam were required due to uncontrolled seizures. During the first hour of hospitalization, severe dyskinesia characterized by abnormal involuntary large hyperkinetic movements in all 4 extremities was observed and successfully treated with 2 doses of intravenous biperiden. The patient was discharged on day 6 of hospitalization. Conclusions. Mexiletine overdose can be life-threatening. In addition to rapid and effective resuscitation, rapid identification and management of cardiovascular and central nervous system manifestations are key to preventing morbidity and mortality. The presented case had severe dyskinesia that was successfully treated with repeated doses of biperiden. Biperiden did not cause arrhythmia. Based on the presented case, we think biperiden should be considered for the treatment of movement disorders in cases of mexiletine overdose. https://turkjpediatr.org/article/view/80biperidendyskinesiaintoxicationmexiletinepoisoning |
| spellingShingle | Zeynelabidin Öztürk Orkun Aydın İlknur Bodur Raziye Merve Yaradılmış Hale Atalay Çelik Nilden Tuygun Dyskinesia due to mexiletine overdose: a rare presentation The Turkish Journal of Pediatrics biperiden dyskinesia intoxication mexiletine poisoning |
| title | Dyskinesia due to mexiletine overdose: a rare presentation |
| title_full | Dyskinesia due to mexiletine overdose: a rare presentation |
| title_fullStr | Dyskinesia due to mexiletine overdose: a rare presentation |
| title_full_unstemmed | Dyskinesia due to mexiletine overdose: a rare presentation |
| title_short | Dyskinesia due to mexiletine overdose: a rare presentation |
| title_sort | dyskinesia due to mexiletine overdose a rare presentation |
| topic | biperiden dyskinesia intoxication mexiletine poisoning |
| url | https://turkjpediatr.org/article/view/80 |
| work_keys_str_mv | AT zeynelabidinozturk dyskinesiaduetomexiletineoverdoseararepresentation AT orkunaydın dyskinesiaduetomexiletineoverdoseararepresentation AT ilknurbodur dyskinesiaduetomexiletineoverdoseararepresentation AT raziyemerveyaradılmıs dyskinesiaduetomexiletineoverdoseararepresentation AT haleatalaycelik dyskinesiaduetomexiletineoverdoseararepresentation AT nildentuygun dyskinesiaduetomexiletineoverdoseararepresentation |