Survival After Severe Rhabdomyolysis Following Monensin Ingestion

Michela Blain, Alexander Garrard, Robert H Poppenga, Betty Chen, Matthew Valento, Melissa Halliday Gittinger

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Introduction: 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. Case: 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%. Discussion: 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. Conclusions: Monensin is a veterinary medication not approved for human use by the US Food and Drug Administration. Though poorly studied in humans, this case demonstrates the severe harm that may occur following ingestion.

Original languageEnglish (US)
Pages (from-to)1-4
Number of pages4
JournalJournal of Medical Toxicology
DOIs
StateAccepted/In press - May 17 2017

Keywords

  • Human
  • Monensin ingestion
  • Monensin toxicity
  • Rhabdomyolysis

ASJC Scopus subject areas

  • Toxicology
  • Health, Toxicology and Mutagenesis

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    Blain, M., Garrard, A., Poppenga, R. H., Chen, B., Valento, M., & Halliday Gittinger, M. (Accepted/In press). Survival After Severe Rhabdomyolysis Following Monensin Ingestion. Journal of Medical Toxicology, 1-4. https://doi.org/10.1007/s13181-017-0616-6