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Fatal nifedipine ingestions in children
D C Lee1, T Greene, T Dougherty
1North Shore University Hospital, Manhasset, New York 11030, USA.
The Journal of Emergency Medicine
|November 14, 2000
Summary
Accidental nifedipine overdose in children can be fatal, contrary to previous reports. Aggressive supportive care, including calcium and epinephrine, was ineffective in two pediatric cases of long-acting nifedipine ingestion.
Area of Science:
- Pharmacology
- Toxicology
- Pediatric Medicine
Background:
- Nifedipine, a dihydropyridine calcium channel blocker, is commonly used for hypertension.
- Overdoses of calcium channel antagonists are typically managed with supportive care.
- Nifedipine overdose is generally considered relatively benign in comparison to other agents.
Observation:
- Two pediatric cases of fatal accidental ingestion of long-acting nifedipine (Adalat) are presented.
- Both children experienced severe hypotension and cardiac conduction abnormalities.
- Standard and aggressive supportive treatments were administered.
Findings:
- Despite intensive medical interventions, including calcium, atropine, epinephrine, glucagon, sodium bicarbonate, and transthoracic pacing, both pediatric patients died.
- This case series suggests that long-acting nifedipine overdose can have a poor prognosis in children.
- The effectiveness of standard supportive care for severe nifedipine poisoning in pediatric populations may be limited.
Implications:
- These findings challenge the established view of nifedipine overdose as benign, particularly in pediatric patients.
- Clinicians should be aware of the potential for severe toxicity and mortality associated with long-acting nifedipine ingestion in children.
- Further research is warranted to understand the specific mechanisms of toxicity and to develop more effective treatment strategies for severe nifedipine poisoning in pediatric populations.