Global electrocardiograph changes and acute pulmonary oedema in an acute hydralazine overdose of a young male: A case study

A 15 year-old male was bought to the unit by ambulance approximately two hours after ingesting 750 mg of hydralazine tablets. The episode was marked with distinct stages of deterioration whereby the patient's symptoms changed as the effects of the drug and treatment progressed. On arrival in the unit the patient was hypotensive and tachycardic but otherwise asymptomatic. Over the course of the next four hours his cardiovascular and respiratory status deteriorated. Widespread electrocardiogram (ECG) changes with related chest pain indicated cardiac ischemia, which was later confirmed by rises in cardiac enzymes. The patient's respiratory status deteriorated with the onset of acute pulmonary oedema (APO). These symptoms progressed to such an extent that he required ionotropic support, intubation and extended ventilation. The possible mechanisms involved in the overdose are discussed.

The incidence of acute hydralazine overdose is rare with only scant mention in the literature of similar incidents. ECG changes have been noted in the literature (Smith & Ferguson, 1992), however the progression of the symptoms to include APO and heart failure have not been noted.