Reality of clonidine poisoning in children and adolescents
Chi Duong1, Caitlyn Lovett2,3, MIchael A Downes3,4
1Emergency Department, Angliss Hospital, Melbourne, Victoria, Australia.
Insights
Paediatric clonidine poisoning often causes bradycardia, hypotension, and reduced GCS. However, severe outcomes are rare, and children ingesting less than 5 mcg/kg typically do not require hospital admission.
Area of Science:
- Toxicology
- Paediatric Medicine
- Clinical Pharmacology
Background:
- Clonidine poisoning in children presents a significant clinical challenge.
- Understanding the spectrum of severity is crucial for effective management.
- Tertiary toxicology services play a key role in managing complex paediatric poisonings.
Purpose of the Study:
- To describe the clinical severity of clonidine poisonings in a paediatric population.
- To identify factors associated with severe outcomes in paediatric clonidine ingestions.
- To inform management guidelines for clonidine overdose in children.
Main Methods:
- Retrospective review of paediatric clonidine poisoning cases (March 2014 - February 2020).
- Categorization of patients into young children (0-6 years), older children (7-11 years), and adolescents (12-17 years).
- Analysis of clinical effects (bradycardia, hypotension, GCS), interventions, and healthcare utilization.
Main Results:
- 111 clonidine poisonings identified; adolescents comprised the largest group.
- 91% of cases experienced at least one abnormal vital sign (bradycardia, hypotension).
- Severe bradycardia and hypotension were more common in younger children and adolescents, respectively; however, major interventions were rare.
Conclusions:
- Paediatric clonidine poisoning frequently leads to bradycardia, hypotension, and decreased GCS.
- Severe outcomes requiring significant intervention are uncommon.
- Children ingesting less than 5 mcg/kg of clonidine generally do not require hospital admission.
Aim:
We aimed to describe the severity of clonidine poisonings in a paediatric population referred to a tertiary toxicology service.
Methods:
We undertook a retrospective review of all presentations of clonidine poisoning in children or adolescents reported to a tertiary toxicology service from March 2014 to February 2020. Cases were divided into young children (0-6 years), older children (7-11 years) and adolescents (12-17 years). We report clinical effects: bradycardia, hypotension and abnormal Glasgow coma score (GCS), based on standard paediatric observation charts, interventions, length of emergency department stay, proportion admitted to a medical ward or paediatric intensive care unit.
Results:
We identified 111 clonidine poisonings, 41 young children, 9 older children and 61 adolescents. There were more females in the adolescent group and slightly more males in the younger age groups. The median dose ingested was 13 mcg/kg (interquartile range: 7-38 mcg/kg), which varied across ages. Clonidine alone was ingested in 78 cases (70%) and co-ingestion was more common in adolescents (24/61; 39%). Thirty-seven patients (33%) were admitted and 23 (21%) were admitted to paediatric intensive care unit. Median length of emergency department stay was 16.4 h, longer for adolescents. At least one abnormal observation occurred in 101 of 111 (91%) cases: 76 of 106 (72%) bradycardia, 76 of 110 (69%) hypotension and 4 of 99 (4%) GCS < 9. Thirteen (12%) had severe bradycardia, more common in young children and 23 (21%) had severe hypotension, more common in adolescents. For 27 children (0-11 years) ingesting 5-10 mcg/kg, 3 (11%) had severe bradycardia or severe hypotension and 1 received naloxone (4%). No cases ingesting <5 mcg/kg developed moderate/severe bradycardia or hypotension. Four cases received naloxone with no significant change, two patients got atropine with a transient response. One patient was intubated to facilitate safe inter-hospital transfer.
Conclusion:
Paediatric clonidine poisoning commonly results in bradycardia, hypotension and decreased GCS, but rarely severe or requiring major interventions. Children ingesting <5 mcg/kg do not require admission.
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