Neuromuscular paralysis caused by an overdose of emepronium bromide

A 30-year-old woman with a history of depression developed puerperal depression treated with ECT and clomipramine. She was prescribed emepronium bromide for urinary tract symptoms and on the moming of admission took 100 tablets. On admission to hospital she refused gastric lavage, was treated with ipecacuanha and returned some tablet residue identified as emepronium. On examination she had widely dilated pupils, a pulse of 130 and a normal body temperature. Four hours after ingestion she became intermittently confused and complained of difficulty in swallowing and breathing. Oxygen was administered by face-mask and blood gases showed a P02 of 200mm Hg and a pCO2 of 55 mm Hg. She was moved to the intensive care unit where she rapidly became very distressed, making jerky limb movements and indicating her inability to breathe. She developed a bradycardia and was ventilated with 100% oxygen by face-mask and given external cardiac massage. Her pulse rate increased and she was intubated following administration of etomidate and suxamethonium. She was mechanically ventilated but continued making jerky limb movements similar to those made by a partially curarized patient, although no fade of train of four ratio could be