{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:26:31Z","timestamp":1787019991395,"version":"build-2736575974"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Guanfacine is an alpha-2 adrenergic agonist that decreases norepinephrine release and sympathetic outflow. With the increased use of guanfacine for attention-deficit hyperactivity disorder (ADHD), reports of guanfacine poisoning have also risen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 15-year-old male (height: 170\u00a0cm, weight: 48\u00a0kg), who was taking 2\u00a0mg\/day of guanfacine for ADHD, was brought to our emergency department after ingesting 40 tablets of guanfacine due to poor exam results. He presented with impaired consciousness and sinus bradycardia on an electrocardiogram (ECG), leading to diagnosis of guanfacine poisoning. Gastric lavage (5 L) was performed, and activated charcoal was administered. Although his consciousness gradually recovered, he developed ST-segment elevation on the ECG. Despite the absence of chest pain and elevated myocardial enzymes, coronary artery stenosis was not observed on coronary artery computed tomography. As his blood guanfacine level decreased, his ECG returned to normal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case highlights the need for careful monitoring of guanfacine poisoning patients due to the potential for various cardiovascular events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12245-024-00634-0","type":"journal-article","created":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T02:02:06Z","timestamp":1714096926000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Guanfacine poisoning resulting in transient ST-segment elevation: a case report"],"prefix":"10.1186","volume":"17","author":[{"given":"Ichiro","family":"Hirayama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshito","family":"Kamijo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroko","family":"Abe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minaho","family":"Nonaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuhiro","family":"Yano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Ishii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiteru","family":"Tominaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,26]]},"reference":[{"key":"634_CR1","first-page":"2149301","volume":"2022","author":"S Mishra","year":"2022","unstructured":"Mishra S, Shekunov J, Derscheid DJ, Canterbury EA, Leung JG. Delayed signs and symptoms of extended release guanfacine overdose in two adolescent patients: implications of monitoring on the psychiatry unit. Case Rep Psychiatry. 2022;2022:2149301.","journal-title":"Case Rep Psychiatry"},{"issue":"1","key":"634_CR2","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1080\/15563650.2019.1605076","volume":"58","author":"EJ Winograd","year":"2020","unstructured":"Winograd EJ, Sollee D, Schauben JL, Kunisaki T, Smotherman C, Gautam S. Pediatric guanfacine exposures reported to the National Poison Data System, 2000\u20132016. Clin Toxicol (Phila). 2020;58(1):49\u201355.","journal-title":"Clin Toxicol (Phila)"},{"issue":"2","key":"634_CR3","doi-asserted-by":"publisher","first-page":"146","DOI":"10.3109\/15563650903505174","volume":"48","author":"AB Minns","year":"2010","unstructured":"Minns AB, Clark RF, Schneir A. Guanfacine overdose resulting in initial hypertension and subsequent delayed, persistent orthostatic hypotension. Clin Toxicol (Phila). 2010;48(2):146\u20138.","journal-title":"Clin Toxicol (Phila)"},{"issue":"2","key":"634_CR4","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/s40272-017-0270-0","volume":"20","author":"A Li","year":"2018","unstructured":"Li A, Yeo K, Welty D, Rong H. Development of guanfacine extended-release dosing strategies in children and adolescents with ADHD using a physiologically based pharmacokinetic model to predict drug-drug interactions with moderate CYP3A4 inhibitors or inducers. Paediatr Drugs. 2018;20(2):181\u201394.","journal-title":"Paediatr Drugs"},{"key":"634_CR5","doi-asserted-by":"publisher","first-page":"256.e5","DOI":"10.1016\/j.ajem.2020.06.080","volume":"39","author":"RE Bridwell","year":"2021","unstructured":"Bridwell RE, Larson NP, Rosenthal JB, Wray J, Baker Z, Cibrario A, et al. Guanfacine toxic ingestion with subsequent cardiogenic pulmonary edema. Am J Emerg Med. 2021;39:256.e5-.e8.","journal-title":"Am J Emerg Med"},{"issue":"12","key":"634_CR6","doi-asserted-by":"publisher","first-page":"641","DOI":"10.2131\/jts.48.641","volume":"48","author":"R Ayata","year":"2023","unstructured":"Ayata R, Fujita M, Harada K, Esaki Y, Koga Y, Hisamoto Y, et al. A case of pulmonary edema due to guanfacine intoxication with measurement of serum guanfacine concentrations. J Toxicol Sci. 2023;48(12):641\u20134.","journal-title":"J Toxicol Sci"},{"issue":"5","key":"634_CR7","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1536\/ihj.15-034","volume":"56","author":"R Kuroda","year":"2015","unstructured":"Kuroda R, Shintani-Ishida K, Unuma K, Yoshida K. Immobilization stress with \u03b12-adrenergic stimulation induces regional and transient reduction of cardiac contraction through Gi coupling in rats. Int Heart J. 2015;56(5):537\u201343.","journal-title":"Int Heart J"},{"issue":"4","key":"634_CR8","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.clinthera.2007.04.016","volume":"29","author":"D Swearingen","year":"2007","unstructured":"Swearingen D, Pennick M, Shojaei A, Lyne A, Fiske K. A phase I, randomized, open-label, crossover study of the single-dose pharmacokinetic properties of guanfacine extended-release 1-, 2-, and 4-mg tablets in healthy adults. Clin Ther. 2007;29(4):617\u201325.","journal-title":"Clin Ther"},{"issue":"2","key":"634_CR9","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1007\/s40268-013-0014-8","volume":"13","author":"B Roesch","year":"2013","unstructured":"Roesch B, Corcoran ME, Fetterolf J, Haffey M, Martin P, Preston P, et al. Pharmacokinetics of coadministered guanfacine extended release and lisdexamfetamine dimesylate. Drugs R D. 2013;13(2):119\u201328.","journal-title":"Drugs R D"}],"container-title":["International Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12245-024-00634-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12245-024-00634-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12245-024-00634-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T02:02:10Z","timestamp":1714096930000},"score":1,"resource":{"primary":{"URL":"https:\/\/intjem.biomedcentral.com\/articles\/10.1186\/s12245-024-00634-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,26]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["634"],"URL":"https:\/\/doi.org\/10.1186\/s12245-024-00634-0","relation":{},"ISSN":["1865-1380"],"issn-type":[{"value":"1865-1380","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,26]]},"assertion":[{"value":"2 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 April 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and accompanying images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"60"}}