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Clonidine Overdose in a Toddler Due to Accidental Ingestion of a Compounding Cream

Alexis L Cates, Scott M Wheatley, Kenneth D Katz

    Pediatric Emergency Care
    |July 26, 2016
    PubMed

    Insights

    A toddler experienced severe toxicity after ingesting a compounded cream, with high clonidine levels causing apnea and vital sign fluctuations. Prompt supportive care led to a full recovery, highlighting the risks of pediatric exposure to such medications.

    Area of Science:

    • Pediatric Toxicology
    • Emergency Medicine
    • Clinical Pharmacology

    Background:

    • Accidental ingestion of compounded medications in children presents unique toxicological challenges.
    • Therapeutic compounding creams often contain multiple active pharmaceutical ingredients, increasing the risk of adverse events.

    Observation:

    • A 22-month-old child ingested a compounded cream containing camphor, gabapentin, clonidine, ketoprofen, and lidocaine.
    • The child presented with altered mental status, apnea, hypothermia, bradycardia, and hypotension.
    • Serum analysis revealed a supratherapeutic clonidine level (2.6 ng/mL) with undetectable levels of other components.

    Findings:

    • Severe toxicity, including respiratory depression and hemodynamic instability, was observed following ingestion.
    • The patient's clinical presentation was primarily attributed to clonidine toxicity.
    • Supportive care, including mechanical ventilation and management of vital signs, was effective in resolving symptoms.

    Implications:

    • Healthcare providers should maintain a high index of suspicion for toxicity from compounded medications in pediatric ingestions.
    • Enhanced parental education regarding the safe storage and administration of compounded medications is crucial.
    • This case underscores the potential for severe adverse events even with limited exposure to certain pharmaceutical compounds.

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