Pediatric ingestions with gummy formulated medications: a retrospective study.

CONTEXT: Gummy formulations are widely available with estimated 65% marketed for children. Currently, there are few studies describing children ingesting gummy formulated medications. The aim of this study was to quantify and identify the type of ingestions due to gummy formulated medications, evaluate their clinical significance as defined by adverse outcomes: associated symptoms, emergency department (ED) visits, and hospitalizations. METHODS: Retrospective study in children aged 0-19 exposed to gummy formulated medications from 2015 to 2017 as identified by calls made to the Regional Poison Control Center (RPCC). A list of potentially toxic gummy formulated medications was compiled and reviewed by medical and clinical toxicologists. We categorized medications into vitamins, minerals and supplements, melatonin, and other. Data collected included: medication name, number of units, age, sex, symptoms described, ED visit, hospitalization, and unintentional or intentional ingestion. DISCUSSION: Of the 66,059 pediatric exposures received by RPCC, 1143 (1.7%) involved gummy formulated medications of which 1098 were analyzed. Median age was 3 years, 57.7% were males and 7% were symptomatic. Seventy-four percent exposures involved vitamins and 24% melatonin. In comparison to other gummy exposures, those who ingested melatonin had 8.4 times higher odds of being symptomatic (OR: 8.4, 95% CI: 5.1, 14) and 4.8 times higher odds of visiting ED (OR: 4.8, 95% CI: 2.5, 9). The predominant symptoms reported were drowsiness, gastrointestinal upset, and hyperactivity. Two patients were hospitalized who ingested multiple medications, one was unintentional, and one was intentional as a suicide attempt thus admitted for psychiatric stabilization. CONCLUSIONS: Gummy formulated medications comprised <2% of the total pediatric calls to the RPCC. Although, the occurrence of symptoms is rare, these medications especially those containing melatonin should be safely stored.

A new after-hours clinic model provides cost-saving, faster care compared with a pediatric emergency department.

OBJECTIVE: The objective of this study was to compare the charges and length of stay of demographically and clinically matched nonemergent patients managed in a new After-Hours Clinic (AHC) model versus a pediatric emergency department (PED). METHODS: Retrospective cross-sectional study conducted in a tertiary-care urban academic children's hospital. The AHC was off-site from the children's hospital emergency department. After-Hours Clinic patients were matched with PED patients for age, date and time of presentation, and chief complaint. The 95% confidence intervals for the difference in the means were used to compare the outcome variables of charges and length of stay. RESULTS: Of 471 patients seen at AHC in January 2008, 130 were matched to PED patients for date and time of presentation, age, and chief complaint, giving 260 study patients. There was no significant difference between AHC and PED patients in relationship to date and time of presentation, sex, age, and chief complaint. Comparing the length of stay and charges between AHC and PED patients revealed a significant difference in each. The patient-visit length-of-stay mean time for the AHC was 81.2 minutes less than the mean time for the PED (95.6 vs 176.8 minutes). The patient-visit mean charge for the AHC was $236.20 less than the mean charge for the PED ($226.00 vs $462.20). CONCLUSIONS: Our AHC model showed a significant reduction in length of stay and charges in compared demographically and clinically matched PED patients. This may be an effective model to help address emergency department overcrowding and promote patient safety.

Descriptive epidemiology of infant ingestion calls to a regional poison control center.

OBJECTIVE: This study was designed to describe the epidemiology of ingestions in infants 6 months of age or younger. METHODS: A retrospective chart review from a convenience sample of poison center cases in infants younger than 6 months of age from December 28, 2002, to December 28, 2003, was reviewed. RESULTS: A total of 358 cases were reviewed. Incorrectly measured dose, repeated dosing by different caregivers, incorrect dosing interval, and incorrect route accounted for 41% [95% CI, (36%, 46%)] of caregiver dosing misadventures. Ten cases (3%) were due to pharmacy error, and the wrong medication was given in 32 (9%) cases. The total therapeutic misadventure proportion was 53%. Eight percent were 10-fold dosing errors. Thirty-nine (11%) infants were evaluated in an emergency department and 9 (3%) infants were admitted to a health care facility. CONCLUSIONS: Therapeutic misadventures caused by dosing errors in infants younger than 6 months of age were prevalent. Most errors occurred with inaccurate measurement of the medication, repeated dosing by caregivers, incorrect dosing interval, and incorrect route. Healthcare providers could increase prevention of therapeutic misadventures by educating caregivers on proper administration of medications and by demonstrating the use of appropriate measuring devices.

Drug-induced rhabdomyolysis.

PURPOSE OF REVIEW: Drug-induced rhabdomyolysis is a common syndrome that is complex and potentially life threatening. This article reviews the pathophysiology, clinical presentations, and common compounds that cause drug-induced rhabdomyolysis. RECENT FINDINGS: The list of drugs and inciting agents that cause rhabdomyolysis is quite extensive. Rhabdomyolysis is defined as skeletal muscle injury that leads to the lysis of muscle cells and the leakage of myocyte contents into the extracellular compartments. The presenting clinical features are myalgias, myoglobinuria, and an elevated serum creatine kinase. There have been several case reports in the literature involving some common pediatric drugs that are associated with rhabdomyolysis. Diphenhydramine, Ecstasy, and baclofen have recently been implicated as the etiology of drug-induced rhabdomyolysis in several pediatric patients. Alkalinization of the urine is a controversial treatment of drug-induced rhabdomyolysis and has proven to be beneficial in some patients. SUMMARY: A high index of suspicion, early recognition, and adequate treatment will result in an excellent prognosis of drug-induced rhabdomyolysis.