A case of pulmonary edema due to guanfacine intoxication with measurement of serum guanfacine concentrations

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  • Ayata Ryo
    Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital
  • Fujita Motoki
    Acute and General Medicine, Yamaguchi University Graduate School of Medicine
  • Harada Kayoko
    Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital
  • Esaki Yusuke
    Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital
  • Koga Yasutaka
    Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital
  • Hisamoto Yukari
    Department of Respiratory Medicine and Infectious Disease, Yamaguchi University Hospital
  • Asami-Noyama Maki
    Department of Respiratory Medicine and Infectious Disease, Yamaguchi University Hospital
  • Takeda Saki
    Department of Forensic Medicine, Fukushima Medical University School of Medicine
  • Harada Kazuki
    Department of Forensic Medicine, Fukushima Medical University School of Medicine
  • Tsuruta Ryosuke
    Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital Acute and General Medicine, Yamaguchi University Graduate School of Medicine

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Abstract

<p>Guanfacine hydrochloride extended-release (GXR) is used to treat attention deficit hyperactivity disorder. It is a selective α2A-adrenorecepor agonist that was reported to cause QT prolongation and hypotension in the event of overdosing. We report the case of a 17-year-old man who took 226 tablets of GXR 3 mg for attempted suicide. He was found complaining of dyspnea, and emergency medical services were called. When the patient was transferred to our hospital, his Glasgow coma scale was 12 (E4V3M5). He was agitated and hypoxemic. He was intubated for invasive mechanical ventilation under sedation. His chest X-ray and computed tomography scan showed pulmonary edema. Transthoracic echocardiography showed markedly reduced cardiac function. His serum guanfacine concentration peaked on day 3 after admission. His pulmonary edema improved quickly after a decrease in serum guanfacine concentration, but cardiac decompensation persisted for about 1 month. This case reveals that the decline in cardiac function after guanfacine intoxication is prolonged even after its serum concentration has decreased.</p>

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