Key result
Severe guanfacine intoxication resulted in pulmonary edema and agitation that improved with declining serum concentrations, while reduced cardiac function persisted for approximately one month.
Case Report (n=1)
No
Guanfacine intoxication can cause severe pulmonary edema and prolonged cardiac dysfunction that persists even after serum concentrations have normalized.
Prolonged cardiac monitoring may be warranted after guanfacine intoxication; this Level 5 case leaves open questions on prevalence and mechanisms.
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.
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Ayata et al. (2023) conducted a case report in Guanfacine intoxication (n=1). Guanfacine overdose was evaluated on Serum guanfacine concentration and clinical course. Severe guanfacine intoxication resulted in pulmonary edema and agitation that improved with declining serum concentrations, while reduced cardiac function persisted for approximately one month.
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