Orphenadrine poisoning in a child: clinical and analytical data

Orphenadrine is an anticholinergic drug used mainly in the treatment of Par kinson's disease. It has a peripheral and central effect and a known cardio toxic effect when taken in large doses. We report the successful outcome of the treatment of a 2 1/2-year-old girl who accidentally ingested 400 mg of orphenadrine hydrochloride (Disipal). One hour after ingestion she present ed neurological symptoms: confusion, ataxic walking, and periods of severe agitation. Generalized tonic-clonic seizures appeared resistant to the admi nistration of multiple antiepileptics. They ceased after a supplementary do se of intravenous diazegam, endotracheal intubation, and mechanical ventila tion. An episode of ventricular tachycardia responded well to i.v. lidocain e. Physostigmine was administered in three successive doses. The initial or phenadrine plasma level (3,55 mu g/ml) was in the toxic range, associated w ith high mortality. The calculated elimination half-life was 10.2 h and the molecule and/or its metabolites were found up to 90 h after ingestion.