Survival After Severe Rhabdomyolysis Following Monensin Ingestion

Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology
Michela BlainMelissa Halliday Gittinger

Abstract

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. 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%. 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. Monensin is a veterinary medication not approved for human use by the US Food and Drug Administration. Though poorly studied in humans, this ...Continue Reading

References

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May 28, 2011·Journal of Veterinary Pharmacology and Therapeutics·J HenriP Sanders

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Citations

Dec 12, 2020·Toxicology and Industrial Health·Zhiqiang ZhangJinying Zhang
Oct 31, 2020·International Journal of Environmental Research and Public Health·Xiuge GaoShanxiang Jiang
Mar 2, 2021·Food Research International·Felipe Rodrigues Nogueira SilvaAdriana Pavesi Arisseto-Bragotto

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