AMPHOTERICIN-B OVERDOSE IN PEDIATRIC-PATIENTS WITH ASSOCIATED CARDIAC-ARREST

OBJECTIVE: To report the first five cases of amphotericin B overdose w ith secondary cardiac complications in a pediatric population. Treatme nt is also presented. SETTING: Hospital. PATIENTS: Two infants and thr ee children inpatients receiving amphotericin B. INTERVENTIONS AND RES ULTS: Cardiac complications were observed in five pediatric patients w ho received between 4.6 and 40.8 mg/kg/d of amphotericin B. Cardiac ar rest occurred in all patients, and four patients died. A detailed desc ription of the cardiac event is provided for one patient who was on a cardiac monitor during the adverse reaction. Hydrocortisone prophylaxi s and verapamil therapy were the primary therapies used in patient 1 ( the only survivor). Evaluation of the literature provides substantial evidence for the use of hydrocortisone in prevention of cardiac arrhyt hmias. CONCLUSIONS: Amphotericin B overdose can be fatal in children a nd infants. The presentation in humans appears similar to that in dogs where cardiac arrhythmias occurred at doses of 5-15 mg/kg. Hydrocorti sone may decrease the incidence of mortality associated with cardiac a rrhythmias in children receiving amphotericin B overdoses. Animal stud ies are necessary to evaluate this observation and potential disadvant ages of hydrocortisone usage.