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Propranolol is generally safe in children, even at high doses. However, children on chronic propranolol therapy require monitoring for hypoglycemia, especially when caloric intake is reduced.
Area of Science:
- Pediatric Pharmacology
- Cardiovascular Therapeutics
- Adverse Drug Events
Background:
- Propranolol is a beta-blocker medication used for various pediatric conditions.
- Assessing propranolol's safety profile in children is crucial for effective therapeutic use.
- Understanding potential adverse effects, such as hypoglycemia, is essential for patient management.
Observation:
- A healthy 3-year-old boy experienced very high plasma propranolol concentrations (2,289 ng/ml) after acute ingestion, with only a diminished heart rate response.
- A 4-year-old boy on chronic propranolol therapy for renovascular hypertension developed hypoglycemia and seizure after refusing food for three days due to an oral wound.
Findings:
- Acute, high-dose propranolol exposure in a healthy child did not result in severe adverse effects.
- Impaired caloric intake in children on chronic propranolol therapy can precipitate hypoglycemia, requiring prompt medical intervention.
Implications:
- Propranolol appears to have a wide safety margin in acute pediatric overdose scenarios.
- Vigilance for hypoglycemia is critical in pediatric patients receiving chronic propranolol, particularly during periods of reduced food intake.
- This highlights the importance of individualized monitoring and management strategies for pediatric patients on beta-blocker therapy.
Abstract:
Four hours after acute ingestion of 400 to 1,200 mg of propranolol by a healthy, 3-year-old boy, his plasma concentration of propranolol was 2,289 ng/ml. The only pharmacologic effect observed was a diminished heart rate response to crying and activity. In a second case, a 4-year-old boy on chronic propranolol therapy for renovascular hypertension had a hypoglycemic seizure when solid food was refused for three days because of an oral wound. The hypoglycemia was easily managed with intravenous glucose, and there were no sequelae. The first case alludes to the safety of propranolol in a healthy child even with very high plasma concentrations. The second case suggests the necessity of anticipating and avoiding hypoglycemia that can develop in children on chronic propranolol therapy when caloric intake is impaired.