Beta-adrenergic antagonist exposures in children

Area of Science:

• Toxicology
• Pediatric Emergency Medicine
• Pharmacology

Background:

• Limited toxicological data exists for pediatric beta-adrenergic antagonist (BA) exposures.
• Current triage practices for unintentional pediatric BA ingestions lack standardization nationwide.
• Understanding clinical manifestations is crucial for effective management of pediatric BA exposures.

Purpose of the Study:

• To survey regional poison centers regarding their triage practices for pediatric BA exposures.
• To characterize the clinical manifestations of unintentional pediatric BA ingestions.
• To assess the toxicity profile of beta-adrenergic antagonists in young children (<7 years).

Main Methods:

• Nationwide survey of 49 regional poison centers on BA triage practices.
• Retrospective 7-year review of acute BA exposures in children (<7 years) at one regional poison center.
• Data analysis included response rates, triage guidelines, common agents, and clinical outcomes.

Main Results:

• 67% of surveyed poison centers lacked established BA triage guidelines for young children.
• 42% of centers referred children to the hospital for any BA ingestion.
• Metoprolol and atenolol were most common; 83% of exposures involved <=1 tablet. Significant clinical effects (lethargy, bradycardia, hypotension) were rare (8/378), with most children experiencing no or minor effects.

Conclusions:

• Regional poison centers frequently over-refer children with BA exposures due to lack of specific guidelines.
• The majority of unintentional pediatric BA ingestions involve small amounts and result in minimal toxicity.
• Further research is needed to establish a clearer toxicity range for beta-adrenergic antagonists in children.