Acute encephalopathy with concurrent respiratory and metabolic disturbances in first known parenteral human administration of flunixin meglumine and acepromazine maleate

• Published in: The Journal of emergency medicine 2013-08, Vol.45 (2), p.206-209
• Main Authors: Kamali, Michael F., MD, Wilson, Anwar C., MD, Acquisto, Nicole M., PHARMD, Spillane, Linda, MD, Schneider, Sandra M., MD
• Format: Article
• Language: English
• Subjects: acepromazine; Acepromazine - poisoning; Acute Disease; Adult; Alkalosis, Respiratory - chemically induced; Banamine; Clonixin - analogs & derivatives; Clonixin - poisoning; Dopamine Antagonists - poisoning; Emergency; equine; Female; flunixin; human; Humans; Metabolic Diseases - chemically induced; Neurotoxicity Syndromes - etiology; nonsteroidal anti-inflammatory drug; Prostaglandin Antagonists - poisoning; veterinary
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2012.11.088

Abstract Background 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. Case Report 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.