Angiotensin converting enzyme inhibitor ingestion in children

The effect of angiotensin converting enzyme inhibitors on children is not well documented. A recent increase in popularity of the angiotensin converting enzyme inhibitors has resulted in an increased availability in the home with resulting heightened probability of accidental ingestion of angiotensin converting enzyme inhibitors by children. In response to this we did a retrospective study of angiotensin converting enzyme inhibitor ingestions in children (ages 1-5 years) from two regional poison centers certified by the American Association of Poison Control Centers. The records of the Delaware Valley Regional Poison Control Center and the New Jersey Poison Information Education Systems were reviewed for 1986 and 1987. Forty-eight angiotensin converting enzyme inhibitor exposures in children 1-5 were identified. Twenty exposures (12.5-300mg captopril, 5-15mg enalapril) were managed with syrup of ipecac in a hospital emergency room. All 20 remained asymptomatic for their stay. None required admission to the hospital. Seven exposures (12.5-75mg captopril, 5-10mg enalapril) were managed at home with syrup of ipecac and 1-, 4-, 24-hour follow up by telephone. All 7 remained asymptomatic. 16 exposures (12.5-100mg captopril, 5-30mg enalapril) were managed by phone at home with observation alone and 4-6 hour follow up. All 16 remained asymptomatic. Five exposures were lost to follow up. A larger series is needed to determine risk, but home monitoring seems adequate for children ingesting no more than the therapeutic dose for adults (12.5-100 mg captopril, 5-30 mg enalapril).