Pediatric poisoning from over-the-counter imidazoline-containing products

We present two instructive cases of imidazoline poisoning in young children. Imidazoline decongestants, readily available in numerous non-prescription preparations, can rapidly produce toxicity from oral ingestion and topical application. Signs and symptoms depend on whether peripheral or central alpha 2-adrenergic receptor stimulation predominates. Timely diagnosis depends on a high index of suspicion and careful questioning about the availability of these over-the-counter products. Standard toxicologic management will prevent significant morbidity. No specific antidote exists.