Chemical peel

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No apparent petechiae, purpura or skin abnormalities were noted. Alcohol, acetaminophen and salicylate levels were negative. An electrocardiogram showed sinus tachycardia with a ventricular rate of 151 beats per minute with normal axis and intervals. A urine enzyme-mediated immunotransferase screen for drugs of abuse was negative, and human immunodeficiency screen was also negative.

A cyproheptadine level obtained approximately 12 hours after exposure was 0. Chemical peel consultation with the toxicology service cjemical recommendation was for the patient to be admitted overnight for observation and supportive care. She was subsequently admitted to the pediatric stepdown unit and had a progressive improvement in her symptoms. After 24 hours of peeel observation chemical peel was asymptomatic and discharged home.

Cyproheptadine chemical peel an antagonist at muscarinic, H-1 histaminic and serotonergic receptors. It is used in the management of serotonin syndrome, migraine prophylaxis, cold-induced urticaria, appetite stimulation and the chemical peel of allergic reactions. Previously reported cases of pediatric cyproheptadine overdose chemical peel patients with various anticholinergic signs and symptoms.

Our patient also exhibited signs and symptoms that were consistent with anticholinergic toxicity with the exception of urinary incontinence. Urinary incontinence, although not classically associated with anticholinergic toxicity, may occur as a result of overflow incontinence. Chemical peel therapeutic level of cyproheptadine in the chemical peel of obvious toxicity is consistent with the large volume of distribution and largely unknown human pharmacokinetics.

The recommended dose for patients between two- and six-years-old is 0. This case highlights the development of cyproheptadine toxicity in the setting of a therapeutic serum level in a pediatric patient. She was managed chemical peel and johnson levels discharged without further complication.

While there has been one previous pediatric case with a confirmatory serum level reported by Yuan et al. Cyproheptadine is a muscarinic, H-1 histaminic and serotonergic antagonist that can clinically present with an anticholinergic toxicity in the setting chemical peel an overdose. Chemical peel chemiical the first pediatric ingestion of cyproheptadine that clinically presented with evidence of toxicity despite having a therapeutic serum drug level.

Especially in toxicologic emergencies, clinicians should focus chemical peel the clinical case updater and symptoms of the patient rather than the quantitative serum levels obtained.

This case highlights the need chemicap clinicians to continue to rely on their physical exam when evaluating patients with suspected toxic overdose. Vhemical for Correspondence: Terrance Cheical, DO, MPH, St. The authors disclosed none. Remy DC, Raab AW, Rittle KE, et al. A comparison of the antiserotonin, antihistamine, and anticholinergic activity of cyproheptadine with analogues having peell nuclei fused to the 10,11-vinylene bridge. Watemberg NM, Roth KS, Alehan FK, oeel al.

Central anticholinergic syndrome on therapeutic chemical peel chemiczl cyproheptadine. Richmond Chemical peel, Seger Chdmical. Central anticholinergic syndrome in a child: a case report. Blaustein BS, Gaeta TJ, Balentine JR, et al.

Cyproheptadine-induced central anticholinergic syndrome in a child: a case report. Yuan C, Spandorfer P, Miller S, et al. Evaluation chemical peel tricyclic antidepressant false positivity in a pediatric case of cyproheptadine (Periactin) Chemical peel. Graudins Chemical peel, Stearman A, Chan B.

Treatment of chemical peel serotonin syndrome with cyproheptadine. Serotonin syndrome: early management with cyproheptadine.

Lewis DW, Diamond Chemical peel, Evitex D, et al.

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