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Pediatric poisoning from trimedoxime (TMB4) and atropine automatic injectors

Eran Kozer1, Amnon Mordel, Shmuael Bar Haim

  • 1Sakler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. erank@asaf.health.gov.il

The Journal of Pediatrics
|January 13, 2005
PubMed

Insights

Unintentional pediatric injection of atropine and trimedoxime (TMB4) via automatic injectors rarely causes significant side effects, even with adult doses in children. Most side effects were mild and related to atropine.

Area of Science:

  • Pediatric Toxicology
  • Emergency Medicine
  • Pharmacology

Background:

  • Automatic injectors (AIs) containing atropine and trimedoxime (TMB4) are used for treating nerve agent exposure.
  • Accidental pediatric exposure to these AIs can occur, necessitating an understanding of potential adverse effects.

Purpose of the Study:

  • To investigate the clinical effects and safety profile of unintentional pediatric exposure to combined atropine and TMB4 from automatic injectors.

Main Methods:

  • Retrospective data collection from the Israel Poison Information Center and pediatric emergency departments.
  • Analysis of demographic data, AI type, injection details, and clinical manifestations in 142 pediatric patients.

Main Results:

  • Most patients received age-appropriate doses; however, 15.5% received higher doses.
  • Mild atropine-related side effects observed included dilated pupils, dry mucous membranes, and tachycardia.
  • Children receiving higher doses were more likely to be symptomatic (P = .029).
  • No significant side effects were attributed to TMB4, and no specific medical intervention was required.

Conclusions:

  • Unintentional pediatric exposure to atropine and TMB4 via AIs, even at adult doses, is generally safe.
  • The observed side effects are typically mild and transient, primarily linked to atropine.
Abstract

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