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Clonidine poisoning--an emerging problem: epidemiology, clinical features, management and preventative strategies
1Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Insights
Clonidine poisoning in children has increased, likely due to its use for behavioral disorders. Current safety measures and management protocols for clonidine poisoning require improvement.
Area of Science:
- Pediatric Toxicology
- Pharmacovigilance
- Childhood Behavioral Disorders
Background:
- Clonidine is increasingly prescribed for childhood behavioral disorders.
- Potential for increased risk of clonidine poisoning in pediatric populations.
- Need to assess the trend of clonidine poisoning incidence.
Purpose of the Study:
- To determine if the incidence of clonidine poisoning in children has risen.
- To correlate potential increases with the use of clonidine for behavioral issues.
- To review clinical presentation, management, and outcomes of pediatric clonidine poisoning.
Main Methods:
- Retrospective review of 14 hospital-admitted clonidine poisoning cases (1985-1995).
- Demographic data collection for each admission.
- Comprehensive literature review on clonidine poisoning incidence, presentation, and management.
Main Results:
- 14 cases of clonidine poisoning identified; 8 occurred in the last 2 years of the study period.
- Eight children or their siblings had clonidine prescriptions for behavioral disorders.
- Common symptoms included altered consciousness (71%) and bradycardia (50%); all cases had favorable outcomes with interventions like activated charcoal, gastric lavage, or induced emesis.
Conclusions:
- The incidence of clonidine poisoning in children has significantly increased.
- This rise is likely linked to increased clonidine use for childhood behavioral disorders.
- Inconsistent management practices and inadequate safety measures (packaging, education) highlight a need for improvement.
Objective:
To ascertain whether the incidence of clonidine poisoning in children has increased given the probable increase in clonidine use for treatment of childhood behavioural disorders.
Methods:
Cases of clonidine poisoning requiring hospital admission between 1985-95 inclusive were reviewed and demographic data pertinent to each admission were recorded. A literature review was also performed, with particular emphasis on incidence, clinical presentation and management of clonidine poisoning.
Results:
There were 14 cases of clonidine poisoning during the specified period eight cases presenting in the last 2 years. These eight children or their siblings had been prescribed clonidine for behavioural disorders. The most common signs at presentation were alteration of conscious state (71%) and bradycardia (50%). Nine children were given activated charcoal while seven cases underwent gastric lavage or induced emesis. Although six children were admitted to intensive care, length of hospital stay was less than 24 h in all cases and all had a favourable outcome.
Conclusion:
We concluded that the incidence of clonidine poisoning had increased over the specified period and that, based on our results, this was likely to be due to an increase in clonidine use in childhood behavioural disorders. Based on our data and that from literature review it was evident that there are inconsistencies in the management of clonidine poisoning and that safety measures, namely packaging and education, are inadequate given the increasing profile of clonidine use.