Acute encephalopathy with concurrent respiratory and metabolic disturbances in first known parenteral human administration of flunixin meglumine and acepromazine maleate.
Abstract: Flunexin is a nonsteroidal anti-inflammatory drug approved for veterinary use in horses and cattle. Acepromazine is a phenothiazine derivative used in horses, dogs, and cats. Human exposure to these substances is rare. Methods: We report a case of a human injection of two equine medications, flunixin and acepromazine, which resulted in altered mental status, respiratory alkalosis, gastrointestinal bleeding, and elevation of liver transaminases in a 43-year-old woman who worked as a horse trainer. The patient intentionally self-injected these medications and subsequently presented to the Emergency Department with altered mental status and lethargy. The patient required hospitalization for metabolic abnormalities, including respiratory alkalosis, and suffered a gastrointestinal bleed requiring blood transfusion. The patient ultimately recovered with supportive measures. We believe this to be the first case of concomitant injection of flunixin and acepromazine in a human. Conclusions: This report explains a case of parenteral administration of two equine medications and the subsequent complications in a patient that presented to the Emergency Department. Human exposure to veterinary medications cannot be predicted by their effect in animals due to variations in absorption, distribution, and metabolism. Physicians should be aware that individuals who work with animals may have access to large quantities of veterinary medicine. This case also exemplifies the challenges that Emergency Physicians face on a daily basis, and generates additional consideration for overdoses and intoxications from medications that are not considered commonplace in humans.
Copyright © 2013 Elsevier Inc. All rights reserved.
Publication Date: 2013-03-20 PubMed ID: 23522957DOI: 10.1016/j.jemermed.2012.11.088Google Scholar: Lookup
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Summary
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The research article discusses a case where a human self-injected with two equine drugs – Flunixin and Acepromazine, experiencing serious health issues like altered mental status, respiratory troubles, gastrointestinal bleeding, and elevated liver transaminases, but recovered eventually.
Case Background
- The reported case involves a 43-year-old woman working as a horse trainer who intentionally self-injected herself with two veterinary medications, Flunixin and Acepromazine.
- These compounds are normally used in horses, dogs, and cattle, and human exposure is rare. Flunixin is a non-steroidal anti-inflammatory drug, while Acepromazine is a phenothiazine derivative.
- Post-administration of these drugs, the woman experienced altered mental status and lethargy leading her to visit the emergency department.
Treatment and Complications
- The woman required hospitalization due to metabolic abnormalities, specifically respiratory alkalosis, a condition where there’s a lower-than-normal concentration of carbon dioxide in the blood.
- She also suffered from a substantial gastrointestinal bleed that necessitated a blood transfusion.
- Despite the serious health matters, the patient eventually got better through supportive measures.
- The authors state this is the first known case of concurrent injection of Flunixin and Acepromazine in a human.
Research Conclusion
- The article concludes by highlighting the unpredictable impacts of human exposure to veterinary medications, owing to the differences in absorption, distribution, and metabolism between humans and animals.
- Given that individuals working with animals may have access to large amounts of veterinary medicine, physicians need to be aware of the possibility of such rare cases occurring.
- This case study, furthermore, emphasizes the challenges faced by Emergency Physicians, who sometimes encounter overdoses and intoxications from uncommon drugs in humans.
Cite This Article
APA
Kamali MF, Wilson AC, Acquisto NM, Spillane L, Schneider SM.
(2013).
Acute encephalopathy with concurrent respiratory and metabolic disturbances in first known parenteral human administration of flunixin meglumine and acepromazine maleate.
J Emerg Med, 45(2), 206-209.
https://doi.org/10.1016/j.jemermed.2012.11.088 Publication
Researcher Affiliations
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA.
MeSH Terms
- Acepromazine / poisoning
- Acute Disease
- Adult
- Alkalosis, Respiratory / chemically induced
- Clonixin / analogs & derivatives
- Clonixin / poisoning
- Dopamine Antagonists / poisoning
- Female
- Humans
- Metabolic Diseases / chemically induced
- Neurotoxicity Syndromes / etiology
- Prostaglandin Antagonists / poisoning
Citations
This article has been cited 1 times.- Algren DA, Ashworth A. Acute acepromazine overdose: clinical effects and toxicokinetic evaluation.. J Med Toxicol 2015 Mar;11(1):121-3.
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