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May 22, 1948

NEOSTIGMINE TOXICITY: Report of Fatality Following Diagnostic Test for Myasthenia Gravis

Author Affiliations

Baltimore, Maryland

From the Office of the Chief Medical Examiner, Baltimore, and the Department of Medicine, Johns Hopkins University.

JAMA. 1948;137(4):362-363. doi:10.1001/jama.1948.82890380001009

Since the introduction of neostigmine as an aid in the diagnosis of myasthenia gravis,1 it has been widely used for this purpose. Its injection in small doses is generally regarded as a relatively safe procedure. No reports of fatal reactions to its diagnostic use are found in the literature.

REPORT OF A CASE  A white man aged 39 consulted his physician because of generalized weakness for about two months. The history and physical examination were not remarkable except for some ptosis of the eyelids. As a therapeutic test for myasthenia gravis, 1 cc. of a 1:2,000 solution of neostigmine methylsulfate2 was injected intramuscularly. No changes were noted for the first few minutes after injection. Then a generalized convulsive seizure occurred, five minutes after the administration of the neostigmine.No fasciculations were noted at this time. Ten minutes after the injection, salivation and respiratory difficulty were noted, and the