27 November 2023: Articles
Excessively High Chronic Propranolol Overdose in Infantile Hemangioma: A Case Report
Management of emergency care
Heba Alshammari B , Alhanouf Alessa B , Yasmin Elsharawy B , Ashjan Alghanem E , Abdullah M. Alhammad A*DOI: 10.12659/AJCR.941765
Am J Case Rep 2023; 24:e941765
Table 1. Case summary.
| Event timeline in weeks | Patient variables | Event | Objective | Management | Propranolol prescribed dose and instructions | Actual dose in (mL) given from 40 mg/5 mL |
|---|---|---|---|---|---|---|
| Week 1 | Age: 29 wksHT: 60 cmWT: 5.8 kg | Dermatology clinic: newly diagnosed as case of IH | Solitary well-defined regular bright red plaque on the lateral right thigh with half of the lesion seems to be fading in color, measuring 7×4 cm | Timolol ophthalmic drops as topical on the lesion: 1 drop 3 times daily | N/A | N/A |
| Week 12 | Age: 41 wksHT: 64 cmWT: 6.3 kg | Dermatology clinic: Follow-up appointment | IH improved | Continue Timolol ophthalmic drops as topical on the lesion: 1 drop 3 times daily. Started on oral propranolol 1 mg/kg/day | 3.15 mg orally twice daily take 0.4 mL orally twice daily | 3 mL twice daily =7.6 mg/kg/day |
| Week 18 | Age: 47 wksHT: 70 cmWT: 6.7 kg | Dermatology clinic: Follow-up appointment | The mother reported a change in skin lesions since the last visit | Continue Timolol ophthalmic drops as topical on the lesion: 1 drop 3 times daily. Increased propranolol to 2 mg/kg/day | 6.5 mg orally twice daily take 0.8 mL orally twice daily | 6.5 mL twice daily =15.5 mg/kg/day |
| Week 19 | Age: 48 wksHT: 70 cmWT: 6.7 kg | Medication refill: propranolol was finished before the next appointment. ED referral from an outpatient pharmacy | Upon admission to the ED, the baby was vitally stable. All laboratory test results were unremarkable. pink, not jaundiced, no new rashes. IH over right thigh measuring 6×4 cm | Patient asymptomatic (chronic overdose) Decontamination: no need Supportive management: none Patient discharged home with parents education about tapering plan | Per tapering plan | Per tapering plan |
| Week 22 | Age: 51 wksHT: 72 cmWT: 7.3 kg | Dermatology clinic: Follow-up appointment. On propranolol 6.5 mg twice daily | Tapering completed Well-defined erythematous plaque measuring 9.8×5 cm | Continue Timolol ophthalmic drops as topical on the lesion: 1 drop 3 times daily. Propranolol dose increased to 2.2 mg/kg/day | 8 mg orally twice daily take 1 mL orally twice daily | 1 mL twice daily |
| Week 28 | Age: 57 wksHT: 72 cmWT: 7.4 kg | Dermatology clinic: Follow-up appointment | Well-defined erythematous plaque measuring 9.5×5 cm plaque is thinner with the area of whitening.The mother reports that it is improving in terms of color (fading) | 8.5 mg orally twice daily take 1.1 mL orally twice daily | 1.1 mL orally twice daily | |
| HT – height; WT – weight; IH – infantile hemangioma; N/A – not applicable; ED – Emergency Department. | ||||||