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Accidental ingestion of sustained release calcium channel blockers in children
1Department of Emergency Medicine, University of Rochester Medical Center, NY 14642, USA.
Insights
Small ingestions of sustained-release calcium channel blockers (SR-CCBs) in children did not cause symptoms. Current monitoring recommendations vary widely, suggesting prolonged observation may not be necessary.
Area of Science:
- Pediatric Toxicology
- Cardiovascular Pharmacology
Background:
- Calcium channel blockers (CCBs) are common medications.
- Pediatric ingestions of CCBs require careful management.
- Sustained-release formulations (SR-CCBs) may have different toxicity profiles.
Purpose of the Study:
- To evaluate the effects of small SR-CCB ingestions in young children.
- To characterize current Poison Control Center (PCC) recommendations for monitoring.
- To assess the necessity of prolonged observation after SR-CCB ingestion.
Main Methods:
- Two-part study: telephone survey of 33 US Poison Control Centers (PCCs) and a 5-year retrospective chart review of pediatric CCB ingestions (<4 years).
- Survey focused on management of small SR-CCB ingestions.
- Chart review analyzed cases of CCB ingestions, noting SR-CCB involvement and observation times.
Main Results:
- PCC recommendations for observation duration varied significantly (45% recommended ≥24h, 18% recommended <6h).
- In a retrospective review, 19 of 29 cases involved SR-CCBs; 6 involved only one tablet.
- No symptoms or vital sign abnormalities were reported in any cases, regardless of observation duration.
Conclusions:
- Small ingestions of SR-CCBs in young children appear to be well-tolerated.
- Current monitoring recommendations are inconsistent.
- Prolonged observation (e.g., 24 hours) may not be necessary for asymptomatic children after ingesting small amounts of SR-CCBs.
Abstract:
We examined the effects of small ingestions of sustained release calcium channel blockers (SR-CCBs) in young children and characterized current recommendations regarding monitoring after a suspected ingestion. A 2-part study was performed of pediatric calcium channel blocker (CCB) ingestion: first a telephone survey of 33 randomly selected Poison Control Centers (PCCs) from around the US concerning their recommended management of a small ingestion of sustained release calcium channel blocker in a child, and then a 5-y retrospective review of local cases of CCB ingestions in children under 4 y-of-age. The number of hours of medical observation recommended by the PCCs varied from > or = 24 h (n = 15, 45%) to < 6 h (n = 6, 18%). The retrospective chart review revealed that 19 of 29 local cases involved a SR-CCB, and 6 of these were thought to have ingested only 1 tablet. Observation time varied from > 24 h to < 6 h in the 17 cases seen in an emergency department. No symptoms or vital sign abnormalities were reported in any case. Recommendations regarding duration of observation varied from < 6 h to 24 h. Ingestion of a few SR-CCB tablets was not associated with symptoms, suggesting that admission and 24-h monitoring may not be necessary under those circumstances.