Drugs detected in suspected pediatric exposures: a 5-year review

Given new prescription medications, designer drugs and changes in drug laws, updated data on the most common drugs and compounds in patients presenting with suspected toxic exposures is necessary to ensure appropriate laboratory testing and patient care.

A 5-year retrospective study of toxicology results from pediatric patients presenting with suspected ingestion was performed. Results from over 6,000 urine immunoassay screens and comprehensive urine toxicology analyses via gas chromatography-mass spectrometry were compared at two hospitals in different states.

Drugs of abuse immunoassays were positive in 33% of specimens, with the immunoassays for cannabinoids, benzodiazepines, opiates and amfetamines most often positive. Drugs were detected in 85% of specimens with gas chromatography-mass spectrometry. The most frequently detected compounds were caffeine, nicotine, carboxy-tetrahydrocannabinol, antihistamines, antipyretics, antidepressants, antipsychotics and anticonvulsants with variations in each age division.

These data support reports from United States poison centers in that many pediatric exposures do not involve drugs of abuse.

Clinical providers should be mindful of current prescribing practices and regional drug trends when treating suspected pediatric exposures. States and provinces should seek to maintain regional toxicology laboratories with broad testing capabilities to support clinical providers and to ensure public health.