Michela Blain1, Alexander Garrard2, Robert Poppenga3, Betty Chen4, Matthew Valento4, Melissa Halliday Gittinger4. 1. Department of Medicine, University of Washington, Box 359895, Seattle, WA, 98104, USA. Michela@uw.edu. 2. Washington Poison Center, Seattle, WA, USA. 3. California Animal Health and Food Safety Toxicology Laboratory, University of California, Davis, CA, USA. 4. Division of Emergency Medicine, University of Washington, Seattle, WA, USA.
Abstract
INTRODUCTION: Monensin is a veterinary antibiotic with a narrow therapeutic window that has led to lethal intoxication in many animal species. Only two prior cases of human toxicity have been reported, both fatal. We present the first case of survival from severe toxicity following monensin ingestion. CASE: A 58-year-old man presented with 8 days of vomiting and abdominal pain. Due to delusions of central nervous system toxoplasmosis, he ingested 300 mg of monensin. His laboratory studies revealed severe rhabdomyolysis without renal dysfunction. Total creatine kinase (CK) peaked above 100,000 U/L. His CK decreased to 5192 U/L after 15 days of aggressive hydration and sodium bicarbonate therapy. His ejection fraction on echocardiogram decreased from 69 to 56%. DISCUSSION: Reports on acute clinical effects after human exposure to monensin are limited. Ingestion is known to cause skeletal and cardiac muscle rhabdomyolysis and necrosis. Animal studies demonstrate that monensin's toxicity is due to increases in intracellular sodium concentrations and Ca2+ release. To date, no effective antidotal treatment has been described. CONCLUSIONS: Monensin is a veterinary medication not approved for human use by the US Food and Drug Administration. Though poorly studied in humans, this case demonstrates the severe harm that may occur following ingestion.
INTRODUCTION:Monensin is a veterinary antibiotic with a narrow therapeutic window that has led to lethal intoxication in many animal species. Only two prior cases of humantoxicity have been reported, both fatal. We present the first case of survival from severe toxicity following monensin ingestion. CASE: A 58-year-old man presented with 8 days of vomiting and abdominal pain. Due to delusions of central nervous system toxoplasmosis, he ingested 300 mg of monensin. His laboratory studies revealed severe rhabdomyolysis without renal dysfunction. Total creatine kinase (CK) peaked above 100,000 U/L. His CK decreased to 5192 U/L after 15 days of aggressive hydration and sodium bicarbonate therapy. His ejection fraction on echocardiogram decreased from 69 to 56%. DISCUSSION: Reports on acute clinical effects after human exposure to monensin are limited. Ingestion is known to cause skeletal and cardiac muscle rhabdomyolysis and necrosis. Animal studies demonstrate that monensin's toxicity is due to increases in intracellular sodium concentrations and Ca2+ release. To date, no effective antidotal treatment has been described. CONCLUSIONS:Monensin is a veterinary medication not approved for human use by the US Food and Drug Administration. Though poorly studied in humans, this case demonstrates the severe harm that may occur following ingestion.
Authors: J Henri; R Maurice; G Postollec; E Dubreil-Cheneau; B Roudaut; M Laurentie; P Sanders Journal: J Vet Pharmacol Ther Date: 2011-05-26 Impact factor: 1.786
Authors: Xiuge Gao; Xinhao Song; Runan Zuo; Dan Yang; Chunlei Ji; Hui Ji; Lin Peng; Yawei Qiu; Dawei Guo; Shanxiang Jiang Journal: Int J Environ Res Public Health Date: 2020-10-27 Impact factor: 3.390