Toxicity of antihypertensives in unintentional poisoning of young children.

BACKGROUND: Knowledge is limited about the toxicity of unintentional exposure to antihypertensives in young children (0-6 years of age). OBJECTIVE: Our aim was to research symptoms and poisoning severity in unintentional poisonings in this group of age and determine adequate poisoning management. METHODS: We performed a 10-year retrospective, explorative analysis of the Mainz Poison Center/Germany database with regard to circumstances of poison exposure, dosage, symptoms, and treatment. To be able to relate drug exposure with reported symptoms, analyses were restricted to single drug exposures. Written follow-up information was obtained in about 50% of all cases. RESULTS: A total of 1489 cases were analyzed, of which 957 were single drug exposures with 421 exposures to beta-blocking agents, 364 to inhibitors of the renin-angiotensin system, 122 to calcium channel blockers, and 50 to antiadrenergic drugs. No severe (Poisoning Severity Score [PSS]=3) or fatal poisonings (PSS=4) were reported and, with the exception of atenolol, propranolol, irbesartan, isradipin, clonidine, and moxonidine, no poisonings with a PSS>1. We did not find a significant relationship between dosage, release formulation and symptoms, or PSS. All patients fully recovered without specific treatment. CONCLUSIONS: In young children with unintentional, single drug exposure to the most popular antihypertensive medication (i.e., metoprolol, bisoprolol, ramipril, enalapril, lisinopril, captopril, candesartan, valsartan, amlodipine, and verapamil), only mild symptoms occurred, and hospital evaluation is not a must. However, children with recent exposure to clonidine or moxonidine should be evaluated at a hospital due to an increased likelihood of poisonings of at least moderate severity.

Intoxicación por amitraz / Amitraz poisoning

En nuestro medio, la intoxicación por amitraz y su solvente xileno es una patología poco frecuente, pero puede observarse un aumento en zonas rurales, donde se lo emplea como insecticida-ectoparasiticida. Por tal razón, se cuenta con escasa bibliografía que oriente su manejo en niños. Presentamos el caso de un paciente de 2 años de edad, con ingestión accidental de amitraz, internado en nuestra Unidad de Cuidados Intensivos Pediátricos y que requirió ventilación mecánica. Creemos que comunicar este caso puede ser útil para alertar sobre esta intoxicación, poco frecuente en nuestro medio.(AU)

Poisoning due to amitraz together with its solvent xilene, is an unusual condition although may be increasing in rural areas where it is used as insecticide-ectoparasiticide. At present, there is scare references to orient physicians concerning its handlingin childhood. We present the case of a 2-year-old boy who suffered an accidental intake of amitraz and was admitted into our Pediatric Intensive Care Unit requiring mechanical ventilation. We consider the usefulness of informing the medical community about this case so as to be aware of this rare kind of poisoning in our community.(AU)

Intoxicación por amitraz / Amitraz poisoning

En nuestro medio, la intoxicación por amitraz y su solvente xileno es una patología poco frecuente, pero puede observarse un aumento en zonas rurales, donde se lo emplea como insecticida-ectoparasiticida. Por tal razón, se cuenta con escasa bibliografía que oriente su manejo en niños. Presentamos el caso de un paciente de 2 años de edad, con ingestión accidental de amitraz, internado en nuestra Unidad de Cuidados Intensivos Pediátricos y que requirió ventilación mecánica. Creemos que comunicar este caso puede ser útil para alertar sobre esta intoxicación, poco frecuente en nuestro medio.

Poisoning due to amitraz together with its solvent xilene, is an unusual condition although may be increasing in rural areas where it is used as insecticide-ectoparasiticide. At present, there is scare references to orient physicians concerning its handlingin childhood. We present the case of a 2-year-old boy who suffered an accidental intake of amitraz and was admitted into our Pediatric Intensive Care Unit requiring mechanical ventilation. We consider the usefulness of informing the medical community about this case so as to be aware of this rare kind of poisoning in our community.

Etilefrinhydrochloride tablet ingestion: successful therapy by endoscopic removal of tablet conglomerate.

We report here on a case of etilefrinhydrochloride tablet intoxication in suicidal intention in a female adolescent. Tablet ingestion resulted in the formation of a tablet conglomerate in the stomach, which could neither be effectively treated with activated charcoal nor by gastric lavage. Endoscopic dissemination and removal of the fragments finally led to the elimination of the tables and the symptoms of intoxication resolved completely. The case presented here offers an explanation as to why the use of activated charcoal and/or a gastric lavage may not be successful in some cases of ingestion/intoxication. Endoscopic removal of ingested fragments of the toxic substance, such as etilefrinhydrochloride tablets, may be useful even hours following ingestion and should be considered when treatment with activated charcoal or gastric lavage fail to eliminate toxic substances in cases of tablet ingestion.

Epinephrine overdose-associated hypokalemia and rhabdomyolysis in a newborn.

Epinephrine overdose induces many negative complications in adults because of its alpha- and beta-adrenoreceptor activity. However, complications in newborns or children are rarely described. A 4-day-old, 2004-g female newborn was inadvertently given epinephrine at 100 times the usual dose; she developed hypokalemia and rhabdomyolysis. A nurse erroneously administered 2 mg of epinephrine 1:1000 (1 mg/ml) into a peripheral intravenous line in the patient's right leg. Her potassium level decreased to 2.2 mEq/L. An infusion of potassium chloride 2 mEq/kg/day over 80 hours was required to correct the hypokalemia. Rhabdomyolysis was diagnosed and confirmed from laboratory results of an elevated creatine kinase level (peak 4124 U/L), with 100% creatine kinase-MM isoenzymes. No obvious long-term sequelae were observed. Effective ventilation, proper hydration, electrolyte maintenance, and early detection were assumed responsible for the positive outcome. Medication errors are common with pediatric inpatients, and efforts to reduce them are needed.

Prehospital epinephrine overdose in a child resulting in ventricular dysrhythmias and myocardial ischemia.

INTRODUCTION: Epinephrine overdoses in children have been associated with supraventricular tachycardia. Myocardial ischemia subsequent to epinephrine overdose has not been reported in pediatric patients. CASE REPORT: We report a case of ventricular dysrhythmias and myocardial ischemia in a 5-year-old boy who received 10 times the recommended dose of subcutaneous epinephrine. Prehospital providers administered the epinephrine, believing it was part of a "high-dose" epinephrine protocol. DISCUSSION: There is no role for high-dose epinephrine in the treatment of allergic reactions or asthma. Careful epinephrine dosing, using mg/kg and verifying the volume, dilution, and route of administration is essential to prevent epinephrine toxicity.