Severe Acute Pipazethate HCl Poisoning: A Case Report

Pipazethate hydrochloride is a phenothiazine-derived antitussive drug used for nonproductive coughs, particularly in developing countries, because of its affordability and low sedative effect.It is licensed in Egypt, and a lot of countries in Asia (India, Pakistan, Bangladesh, Malaysia and Japan), Europe (Germany, Italy, Belgium, Switzerland and others in Eastern/Western Europe) and Latin America (Argentina, Brazil, Chile and Peru).While Pipazethate hydrochloride has been used in many countries, it is not currently approved or used in the United States.Nonetheless, safety concerns, especially in children, have reduced its use in high-income nations [1].Overdoses can cause severe neurological, respiratory and cardiac complications, including QT prolongation and life-threatening arrhythmias due to quinidine-like sodium channel blockade [2].Although acute poisoning is rare, paediatric cases often result in coma, seizures or death.Early reports by Antonio da Silva and Bonavita [3, 4] documented fatalities, whereas Abdelnaby et al.[5] demonstrated the utility of lidocaine in managing arrhythmias.Pipazethate's antitussive efficacy, initially validated in clinical trials [4], underscores its historical use despite modern safety challenges.This report details a near-fatal Pipazethate overdose in a 28-month-old child, emphasising clinical management and advocating for improved safety protocols.Arterial blood gas (ABG) analysis at admission revealed severe metabolic acidosis (pH 7.11), hypoxia (pO 2 40.5 mmHg),