Refractory shock following ingestion of topical minoxidil solution

A Very Bad Hair Day: Minoxidil Ingestion Causing Shock and Heart Failure

Minoxidil is a potent directly acting vasodilator previously used in treatment-resistant hypertension. It possesses several serious side effects including fluid retention, worsening of heart failure, reflex tachycardia, angina, myocardial infarction, pericardial effusion, and hypotension. It is currently reserved for treating alopecia and readily available over the counter as a topical formulation. Intentional/accidental ingestion of topical minoxidil can cause refractory circulatory shock requiring aggressive hydration and vasopressor support. We present a case of a young female with unintentional ingestion of minoxidil leading to severe circulatory shock and acute pulmonary edema. Minoxidil, a common hair loss treatment, is highly dangerous if ingested. Immediate identification and treatment are crucial, involving fluid resuscitation and vasopressors for severe circulatory shock. Midodrine, an alpha-adrenergic agonist, can reduce ICU stay by shortening IV vasopressor usage.

The value of speckle tracking echocardiography in diagnosing minoxidil-induced cardiotoxicity: a case report

Minoxidil is a drug designed for the treatment of arterial hypotension. Due to its secondary effect of hypertrichosis, it is also used for alopecia treatment. We present a case of a 50-year-old female patient who was orally consuming Minoxidil for medical reasons. She presented with severe hypotension, requiring vasoactive drugs, and evidence of myocardial injury was detected using speckle tracking echocardiography. It is worth noting that the patient did not have any coronary heart disease, and the myocardial injury was found to be associated with Minoxidil consumption. Remarkably, the patient showed signs of reversal 72 h after stopping the drug. To our knowledge, this is the first reported case of subendocardial injury associated with Minoxidil, using speckle tracking echocardiography. In the resolution of the case, it was essential to rule out differential diagnoses, administer vasopressors, and use the speckle tracking echocardiography, which allowed for the objective assessment of myocardial injury and the monitoring of the patient during their hospitalization.

Successful management of minoxidil 5% toxicosis in 2 cats from the same household

OBJECTIVE

To describe the successful management of 2 cats following ingestion of minoxidil 5%.

SERIES SUMMARY

Two 2-year-old neutered male Savannah cats were presented following suspected minoxidil 5% ingestion. Both cats developed significant myocardial injury, and clinical signs were consistent with congestive heart failure, supported by cardiac troponin I concentrations, echocardiogram, and thoracic radiographs. They required vasopressor therapy and were decontaminated with intravenous lipid emulsion therapy. Following decontamination, both cats were successfully discontinued from vasopressor therapy, and their clinical signs resolved within 24 hours. The cats were successfully discharged without long-lasting cardiac compromise. Their echocardiograms and cardiac troponin concentration 7 weeks after discharge were within reference intervals.

NEW OR UNIQUE INFORMATION

This is the first detailed report of the successful management of cats following minoxidil 5% ingestion.