Background: Imidazoline derivatives are alpha-adrenergic agents used in nose drops and collyria. Intoxication in children can cause severe central nervous system depression and cardiovascular adverse effects, especially in very young children.
Case report: A 1-month old girl was admitted after nose-drop instillation of naphazoline. At the time of admission, she was comatose, pale, hypothermic and presented arterial hypertension, bradycardia and apnea. Arterial hypertension was corrected after intravenous infusion with phentolamine mesylate, an alpha-antagonist agent. All other symptoms disappeared spontaneously 9 hours after the initial instillation.
Conclusions: Imidazoline intoxication due to overdose or accidental ingestion is frequent in children. Because nose drops are widely available without any medical prescription, nasal vasoconstrictors which contain imidazolin derivatives should be discouraged under 7 years of age and kept out of children's reach.