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Clonidine poisoning in young children
J F Wiley1, C C Wiley, S B Torrey
1Department of Emergency Medicine, Children's Hospital of Philadelphia, PA 19104.
Insights
Clonidine poisoning in young children can cause serious symptoms, but it typically doesn't worsen after 4 hours. Naloxone, an antidote, showed inconsistent effectiveness in treating clonidine poisoning.
Area of Science:
- Pediatric Toxicology
- Emergency Medicine
Background:
- Clonidine poisoning in children presents significant clinical challenges.
- Understanding the clinical course and treatment efficacy is crucial.
Purpose of the Study:
- To evaluate the clinical course of clonidine poisoning in children.
- To assess the role of supportive measures and naloxone response.
Main Methods:
- Retrospective review of 47 inpatient records of children with clonidine poisoning.
- Severity assessed using the Pediatric Risk of Mortality (PRISM) score.
- Analysis of clinical findings, symptom progression, and naloxone administration.
Main Results:
- Central nervous system effects (44 patients), bradycardia (25), and respiratory depression (18) were common.
- Most symptoms appeared within 1 hour, with no deterioration after 4 hours.
- Naloxone showed inconsistent improvement, with some patients requiring intubation despite its use.
Conclusions:
- Clonidine poisoning in young children can lead to a broad range of severe symptoms.
- Delayed symptom progression is unlikely in children with normal renal function.
- Naloxone appears to be an inconsistent antidote for pediatric clonidine poisoning.
Abstract:
We reviewed 47 consecutive inpatient records to determine the clinical course, role of supportive measures, and response to naloxone in children with clonidine poisoning. Severity of illness was assigned by means of the "pediatric risk of mortality" (PRISM) score. The children's ages ranged from 9 to 84 months. Central nervous system effects were noted in 44 patients; bradycardia occurred in 25, and apnea or depressed respiration was seen in 18. Thirty-four patients had symptoms within 1 hour of presentation, but no patient had further clinical deterioration more than 4 hours after presentation. Six patients required endotracheal intubation and mechanical ventilation. There was no difference in PRISM score or duration of symptoms between those patients who received naloxone and those who did not. More patients receiving naloxone required intubation, and only three patients had definite improvement after naloxone administration. We conclude that (1) young children who ingest clonidine have a wide spectrum of serious findings, (2) delayed progression of symptoms after clonidine poisoning is unlikely in a young child with normal renal function, and (3) naloxone is an inconsistent antidote for clonidine poisoning.