Abstract Introduction Ivermectin is a broad-spectrum antiparasitic agent approved by the Food and Drug Administration for treating human parasitic infections such as onchocerciasis and intestinal strongyloidiasis. Medical misinformation has fueled dangerous off-label use for unproven indications, including COVID-19 and cancer. At supratherapeutic doses, ivermectin crosses the blood-brain barrier and acts as a potent gamma-aminobutyric acid (GABA) agonist, leading to severe neurotoxicity. This report describes a near-fatal case of ivermectin poisoning resulting from the misuse of a concentrated veterinary formulation, administered via gastrostomy tube with the intent of treating esophageal cancer. Case Description A 74-year-old male with a history of recently diagnosed esophageal squamous cell carcinoma, for which he had refused standard therapy, was brought to the emergency department for an acute change in mental status. His caregiver reported that 8 hours prior, she had administered a veterinary 1% ivermectin solution via his gastrostomy tube. A critical dosing error occurred when she misread the label, administering 44 mL instead of the intended 4.4 mL. This resulted in a 440 mg overdose, 20 times the standard therapeutic dose. The patient was profoundly somnolent with a Glasgow Coma Scale score of 8. He was hypotensive at 87/52 mmHg and tachycardic at 108 bpm. His workup was significant for an anion gap metabolic acidosis (anion gap of 19), non-contrast head CT, and comprehensive toxicology screens were negative; EEG showed no seizure activity. He was admitted to the Intensive Care Unit, where he required emergent intubation for airway protection and a continuous norepinephrine infusion to manage hypotension. With supportive management, the patient had a full neurologic recovery, allowing for successful extubation and cessation of vasopressors within 36 hours. Discussion Misinformation leading to a lack of trust in doctors and the medical community exploded during the COVID-19 epidemic, exacerbated by the internet, social media, and the 24-hour news cycle. This led to non-approved use of many medications not obtained through appropriate medical routes, including veterinary products, in particular, Ivermectin. Misinformation regarding the use of Ivermectin has spread into other fields, such as oncology. This report illustrates the potentially lethal consequences of misinformation when it leads vulnerable patients to be influenced to use dangerous, unapproved veterinary products to treat diseases for which the products are not indicated. It also illustrates that high-dose Ivermectin overdose can be treated in the absence of an antidote with supportive care, giving time for the Ivermectin to clear. This abstract is funded by: None
Betchvaia et al. (Fri,) studied this question.