Initial management of adolescent overdoses

A retrospective study of pediatric patients presenting to a community hospital emergency department with acute intentional toxidromes was conducted. The characteristics of these patients and their initial medical management were reviewed. Forty-six patients were included in this study with 35 recreational overdoses and 11 suicide attempts or gestures. The mean age of these patients was 15.8 (range 10 to 18 years). The most commonly abused substance was ethanol, followed in frequency by benzodiazepines and barbiturates. Initial management centered on active airway management, gastrointestinal decontamination, and extended observation. Ten patients were intubated, lavaged, extubated, and subsequently discharged from the emergency department. Only one patient required hospital admission. The value of toxicologic screens, emergency department endotracheal intubations, gastric lavage, and charcoal/cathartic therapy is discussed.