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Diphenoxylate (Lomotil) overdose in children can cause severe symptoms like coma and respiratory depression. Prompt gastric lavage and naloxone administration are crucial for managing diphenoxylate poisoning in pediatric patients.
Area of Science:
- Pediatric Toxicology
- Emergency Medicine
- Pharmacology
Background:
- Diphenoxylate (Lomotil) is an antidiarrheal agent.
- Pediatric ingestion of diphenoxylate can lead to significant toxicity.
- Previous literature on pediatric diphenoxylate poisoning is limited.
Purpose of the Study:
- To describe the clinical presentation and outcomes of pediatric diphenoxylate ingestions.
- To evaluate the effectiveness of gastric lavage and naloxone in managing diphenoxylate poisoning.
- To assess the safety of diphenoxylate as an antidiarrheal in children.
Main Methods:
- Retrospective case series of 45 children admitted for diphenoxylate ingestion.
- Clinical data including symptoms, ingested dose, and treatment were analyzed.
- Outcomes such as mortality, sequelae, and treatment response were recorded.
Main Results:
- 45 children ingested diphenoxylate, with one fatality; 44 recovered without sequelae.
- Common symptoms included coma (4), drowsiness (32), and respiratory depression (9).
- No dose-response correlation was observed; gastric lavage and naloxone were utilized.
Conclusions:
- Diphenoxylate poisoning in children can cause severe central nervous system and respiratory depression.
- Gastric lavage is recommended even with delayed presentation due to the drug's effect on gut motility.
- Naloxone is the recommended antagonist for respiratory depression or coma.
- The use of Lomotil in children warrants careful consideration due to potential toxicity.
Abstract:
45 children were admitted to hospital after ingesting varying quantities of diphenoxylate (Lomotil). One died and 44 recovered without any sequelae. Four patients were comatose, 32 were drowsy, and 9 suffered respiratory depression. No correlation was found between ingested dose and the severity of symptoms. Because of its action in rendering the gut atonic, removal of diphenoxylate by gastric lavage is mandatory, even in patients admitted at least 24 hours after drug ingestion. Naloxone is the narcotic antagonist of choice, and should be used in all cases where suspected diphenoxylate poisoning leads to respiratory depression or coma. The use of Lomotil as an antidiarrhoeal agent in children is difficult to justify.