Accidental brimonidine poisoning following nasal instillation of eye drops in an infant

We report the case of a young infant who presented with an acute episode of apnoea and hypotension requiring ventilation and stabilisation. The investigations did not show evidence of metabolic derangements, central nervous system infections or sepsis. At 15 hours of admission, the treating team obtained a history of accidental nasal instillation of brimonidine eye drops. The caregiver mistakenly administered glaucoma eye drops at home instead of the normal saline nasal drops and noticed the error only when the brimonidine drops were found in the medicine kit of the baby 15 hours after admission. The baby was successfully treated primarily with supportive measures and a single dose of naloxone. This case highlights the importance of identifying patients with brimonidine toxicity (an alpha-adrenergic agonist) based on symptomatology. Intranasal administration as a route of brimonidine toxicity is rare. The mainstay of treatment is supportive measures, and naloxone may be beneficial in some cases.