Acute Kidney Injury following Ingestion of Topical Minoxidil

Introduction: Our case presents the dangers of ingesting a 5% topical minoxidil solution as well as the factors that may have contributed to the accidental ingestion. Case Description: A 24-year-old, spanish-speaking male with no past medical history presented with altered mental status. The patient was not able to participate in the interview. The patient was reportedly agitated and confused, which prompted his family to call EMS. They denied drug use. He was distressed about hair loss and drank approximately one ounce of 5% topical minoxidil. The patient did not realize the minoxidil was meant to be applied topically, likely due to a language barrier. The exam was remarkable for tachycardia to 130, tachypnea, forceful movements of extremities against restraints, and difficulty to arouse. Patient was normotensive, afebrile, and denied abdominal pain. Labs were notable for sodium 119, chloride 73, bicarb 28 with an anion gap of 18, and creatinine of 3.81 with an unknown baseline. UDS was negative for ethanol. UA wnl. VBG with a pH of 7.38. EKG showed sinus tachycardia. Imaging, including a CXR and CT head, showed no abnormalities. Patient was given IV fluids with significant improvement in his Cr and was discharged without requiring any hemodialysis during hospitalization. Discussion: The maximum recommended dose of oral Minoxidil is 100mg/day. Our patient consumed approximately 1500mg. Minoxidil has been known to cause transient increases in creatinine and blood urea nitrogen, generally resolved with supportive care. Long term studies have shown that minoxidil can cause irreversible kidney damage. There have been a select few case reports discussing severe poisoning after ingestion of topical minoxidil solution, with the most prevalent symptom being profound hypotension. Co-ingestion with alcohol or underlying hepatic disease are considerations in many other toxic alcohol poisonings and may have had a factor in our case. These medications and other cosmetics products are becoming increasingly available over the counter and often do not have black box warnings. This case highlights the importance of obtaining a thorough history and workup, especially in patients who may have a language barrier. Though minoxidil poisonings are rare, understanding the pathophysiology of Minoxidil and the impact on the renal system may lead to better understanding of toxic alcohols such as propylene glycol.