Lomotil poisoning in children.

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.

[Diphenoxylate poisoning]. / Intoxicación por difenoxilato.

During the year 1976, 18 patients intoxicated with lomotil were admitted to the Emergency Service of the Centro Medico La Raza, I.M.S.S. with ages fluctuating between 4 months and 3 years; the average age was 22 mos. 88.8% of intoxications were accidental. Initial manifestations of atropinism and diphenoxylate showed the same proportion and 22% showed mixed symptoms. There were no deaths. All patients were given stomach washings and it was seen that the earlier the washing was given, the lesser the symptoms showed. The specific treatment given was with naloxone chloride (Narcanti) at a dose of 10 micrograms, per kilo and per dose intravenously and was repeated as often as necessary. Response was spectacular with improvement within 15 seconds. No patient showed side-effects to the application of the antagonist. Lomotil intoxication rated up to 15% of the total sum of intoxications admitted.

Lomotil poisoning in children: two case reports.

Lomotil is a proprietary antidiarrhoeal agent in common use. Two cases of Lomotil poisoning, one of them fatal, are described. Symptoms are those of central nervous system depression and atropinism. Treatment consists of gastric emptying, administration of specific narcotic antagonists, cathartics and activated charcoal.

[Analysis of 50 cases of Lomotil poisoning in children]. / Análisis de cincuenta casos de intoxicación por Lomotil en niños

The authors reviewed the clinical histories of 50 children admitted to the Emergency Department of Hospital de Pediatría, C.M.N., I.M.S.S. from 1971 through 1975, with the diagnosis of lomotil intoxication. No differences were found as to sex. Frequency was greater at ages from 2 to 3 years from accidental mechanism, which increased between 1973 to 1975. Lethality was similar to that reported by other authors. In the clinical picture, the depressive action of diphenoxylate and the anticholinergic action of atropine were outstanding, without being possible to establish the limits between the two, with somnolence and flushness as main symptoms. The treatment given followed the purpose to eliminate the toxic: emesis, gastric washing and in cases of respiratory depression, naloxone was given. Therefore, it is concluded that since the value of lomotil in the treatment of diarrhea has not been proved and that the risk of its administration is greater than the benefit, this product should be proscribed, specially for pediatric use.

[Intoxication by diphenoxylate (author's transl)]. / Intoxicación por difenoxilato

Two cases of intoxication by diphenoxylate, inespecific antidiarrheal, depressor of the intestinal motility, are presented. Diphenoxylate is chemically related with meperidine. One case was caused by hipersensitivity and the other one by overdose. Both had a favourable outcome. Existent bibliography was reviewed and clinical signs of this intoxication pointed-out. It is suggested that diphenoxylate should not be prescribed to children under thirty months.