Pediatric ergot alkaloid exposures reported to the California Poison Control System: 1997-2008
1Department of Emergency Medicine, University of California , San Francisco-Fresno, Fresno, CA , USA.
Clinical Toxicology (Philadelphia, Pa.)
|February 18, 2014
Summary
Pediatric ergot alkaloid exposures rarely cause severe toxicity but lead to frequent hospitalizations. Current guidelines should favor home management and shorter emergency department stays for these cases.
Area of Science:
- Pediatric Toxicology
- Pharmacovigilance
- Clinical Pharmacology
Background:
- The toxicity risk of ergot alkaloid medications in children is not well-defined.
- Historical ergot alkaloid toxicity and ergotism necessitate careful triage for pediatric exposures.
- Current triage recommendations for pediatric ergot alkaloid exposures may be inconsistent.
Purpose of the Study:
- To characterize the clinical effects of unintentional ergot alkaloid exposures in pediatric patients.
- To determine the necessity of hospitalization following pediatric ergot alkaloid exposures.
Main Methods:
- Retrospective cohort study of pediatric (< 7 years) ergot alkaloid exposures reported to the California Poison Control System (CPCS) from 1997 to 2008.
- Analysis of case narratives for demographics, agent, dose, exposure route, symptoms, treatment, hospitalization, and outcomes.
- Inclusion criteria applied to 353 out of 374 reported cases.
Main Results:
- The majority of exposures (99%) were oral in route, with a median patient age of 24 months.
- Most common effects were transient gastrointestinal distress (16%) and lethargy (5%).
- Despite few serious outcomes (similar to other poisonings), hospitalizations were disproportionately high (OR 13.8) compared to other pediatric poisonings.
Conclusions:
- Pediatric ergot alkaloid exposures typically result in minor, transient adverse effects.
- A small number of severe toxicity cases were linked to methylergonovine.
- Poison control and ED guidelines should be revised to recommend home management and brief ED observation over extensive critical care admissions.
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