Nystagmus Secondary to Fomepizole Administration in a Pediatric Patient

Abstract

Fomepizole is an alcohol dehydrogenase inhibitor used to treat ethylene glycol poisoning in adults, with only one report describing the use of fomepizole in the pediatric population. We report a case of nystagmus associated with fomepizole treatment of a 6-year-old female who ingested ethylene glycol 15 hours prior to admission. A previously healthy 6-year-old presented to the emergency department mottled, comatose, and with Kussmaul respirations. Initial arterial blood gases: pH 7.11, PO2 200, HCO3 2, base excess -29, and within 20 minutes her pH dropped to 7.03. The patient was responsive to pain only. Initially, crystalluria without fluorescence was observed in the emergency department; 2 hours after admission, the urine fluoresced under Wood's light. Laboratory data were significant for increased anion and osmolar gaps. She was fluid-resuscitated, NaHCO3, thiamine, and pyridoxine were administered, and she was admitted to the pediatric intensive care unit. Within 4 hours of admission, a loading dose of fomepizole (15 mg/kg) was infused due to the severity of the patient's clinical status. Hemodialysis was initiated but discontinued temporarily due to catheter thrombus formation. The initial (3-hour postadmission) ethylene glycol concentration was 13 mg/dL. She developed coarse vertical nystagmus within 2 hours of fomepizole infusion. The ethylene glycol concentration was 5 mg/dL 3 hours after hemodialysis which then was discontinued. No further fomepizole was administered and the child recovered uneventfully. There was no evidence of the more frequently cited adverse events, such as headache, nausea, and dizziness. Fomepizole has been incompletely evaluated in the pediatric population, and the nature and occurrence of adverse events have not been described adequately. The use of fomepizole appeared safe in this patient although she developed transient nystagmus.