Abstract
A 22-year-old woman ingested approximately 240 ml of a disinfectant in a suicide attempt. Chest radiography and echocardiography revealed bilateral, pulmonary edema and apparent cardiac depression, respectively. We suspected cardiac failure and pulmonary edema induced by naphazoline. Symptoms improved following administration of dobutamine, phentolamine, olprinone, and other drugs. The patient was discharged in good condition on day 13 after hospitalization. Although the clinical symptoms suggested naphazoline intoxication, the patient insisted that she had drunk Makiron and thrown away the emptied container. Since currently marketed Makiron S does not contain naphazoline, we initially had difficulty identifying the causative agent. However, drug and toxicological analyses of blood from the patient and on-site inspection confirmed that she had ingested a disinfectant similar to Makiron that contained naphazoline. The pulmonary edema seen in the present case was attributed to synergy of increased pulmonary vascular permeability caused by adrenaline and an idiopathic reduction in cardiac function. In consideration of the pharmacological mechanisms, we initiated treatment with an α-blocker. Following initiation of concomitant PDE III inhibitor administration, marked improvements in cardiac index and pulmonary edema were observed. While acute naphazoline intoxication manifests as various clinical symptoms, no cases of pulmonary edema accompanied by impaired cardiac function as described herein have been reported. The present case was therefore considered to be of importance.
