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Pediatric benzodiazepine ingestion resulting in hospitalization
Insights
Benzodiazepine ingestion in children can cause serious symptoms like ataxia and lethargy, though most recover with supportive care. Flumazenil showed limited benefit in treating severe benzodiazepine toxicity.
Area of Science:
- Pediatric Toxicology
- Clinical Pharmacology
- Emergency Medicine
Background:
- Benzodiazepine overdose is a concern in pediatric populations.
- Characterizing clinical manifestations is crucial for timely diagnosis and management.
Observation:
- A retrospective case series analyzed 46 children hospitalized for benzodiazepine ingestion.
- Exclusion criteria included suicide attempts and polypharmacy ingestions.
- Data spanned from January 1987 to September 1994 across two urban children's hospitals.
Findings:
- Ataxia (87%), lethargy (57%), and coma (35%) were the most common symptoms.
- Lorazepam was the most frequently ingested agent.
- Respiratory depression occurred in 9% of cases, with one requiring intubation.
- Toxicology screens were positive in only 50% of cases.
- Isolated ataxia was sometimes unsuspected by clinicians.
Implications:
- Benzodiazepine overdose in children can present with severe symptoms, necessitating prompt medical evaluation.
- Ataxia is a key clinical indicator of benzodiazepine ingestion in pediatric patients.
- Supportive care and activated charcoal are effective treatments; flumazenil's role in severe toxicity is limited.
- Underdiagnosis is possible when ataxia is the sole presenting symptom.
Objective:
To characterize the clinical findings in children hospitalized for benzodiazepine ingestion.
Method:
Retrospective case series in two urban children's hospitals, with no intervention. Suicide attempts and polypharmacy ingestions were excluded.
Results:
Forty-six children (67% male) with a mean age of 36 months (range 14-127 months) were hospitalized from January 1987 through September 1994. Lorazepam was most frequently ingested (13/41 identified drugs, 32%). The most prevalent symptoms were ataxia (87%), lethargy (57%), coma (Glasgow coma score < 15, 35%; Reed coma score > 0, 22%), and respiratory depression (9%). Duration of symptoms was less than 24 hours in 88% of patients. Isolated ataxia occurred in eight patients; in five of these patients, benzodiazepine ingestion was unsuspected by the physicians. Three parents intentionally administered the benzodiazepine to their child. Only 50% of 32 toxicology screens were positive for benzodiazepines. One child required endotracheal intubation. Flumazenil administration preceded clinical improvement in two other children. The remaining patients received activated charcoal administration and supportive care.
Conclusion:
Children hospitalized for benzodiazepine overdose occasionally had life-threatening symptoms. Ataxia was the most common clinical finding following benzodiazepine ingestion in this series. Flumazenil appeared beneficial for the treatment of severe benzodiazepine toxicity in only two patients. Most children recovered from their overdose uneventfully after receiving activated charcoal and supportive care.