Reasons for Energy Drink Use and Reported Adverse Effects Among Adolescent Emergency Department Patients.

OBJECTIVES: There is concern of energy drink use by adolescents. The objective of this study was to evaluate the energy drink consumption use, frequency, age of first use, reasons for use, influences of choice of brand, and adverse events recorded in a predominant Latino adolescent population. METHODS: Subjects between the ages of 13 and 19 years utilizing emergency department services for any reason at a large county hospital answered a questionnaire about energy drink usage. RESULTS: There were 192 subjects, of which 49% were male and 51% were female. Latino adolescents were 85% of the participants, although other ethnic groups participated including African American, white, and Asian. Reasons for use include 61% to increase energy, 32% as study aide, 29% to improve sports performance, and 9% to lose weight. Twenty-four percent reported using energy drinks with ethanol or illicit drugs including marijuana, cocaine, and methamphetamine. Adverse reactions were reported in 40% of the subjects including insomnia (19%), feeling "jittery" (19%), palpitations (16%), gastrointestinal upset (11%), headache (8%), chest pain (5%), shortness of breath (4%), and seizures (1%). CONCLUSIONS: Both brand name and packaging influenced the choice of energy drink in most subjects. Forty percent reported at least 1 adverse effect. While most adverse effects were not severe, a small number are serious. In addition, we showed intentional ingestion with ethanol and illicit drugs. Of additional concern is that both brand and packaging seem to directly affect choice of energy drink consumed.

Iron poisoning: a literature-based review of epidemiology, diagnosis, and management.

Although seen less frequently than acetaminophen or salicylate poisoning, acute iron poisoning remains a dangerous threat, particularly to pediatric patients. Multiple factors-including legal and manufacturing practices-have changed the landscape of iron poisoning over the decades. Despite these changes, diagnosis and management of iron poisoning have minimally evolved, and the current evidence for iron poisoning is yet based principally on case series, expert consensus, animal studies, and adult volunteer studies. This review article describes in detail the epidemiology of acute iron poisoning as it relates to the pediatric patient, as well as the historical and current array of literature on diagnosis and management.

Central alpha-2 adrenergic eye drops: case series of 3 pediatric systemic poisonings.

Three pediatric patients presented with systemic central alpha-2 agonist poisoning-2 cases of bradycardia and apnea resulting from ingestion of ingestion of apraclonidine, with 1 case requiring intubation, and 1 case of bradycardia and altered mental status requiring intensive care monitoring resulting from therapeutic ophthalmic application of brimonidine. Pediatric poisonings involving central alpha-2 adrenergic agonists have been well described, particularly with the prototypical agent clonidine. Characteristic symptoms include sympatholytic effects such as central nervous system depression, respiratory depression, hypotension, bradycardia, miosis, hypothermia, and hyporeflexia. Although structurally similar to clonidine, these compounds are presumed to be safer for pediatric use because they are more polar and less lipophilic than clonidine, thereby limiting their ability to cross the blood-brain barrier and reducing incidence of centrally mediated effects. Systemic toxicities of alpha-2 agonist ophthalmic preparations in pediatric patients are similar to those seen with clonidine poisonings. Symptomatic patients should be treated in the same manner as patients with clonidine poisoning. Treatment of systemic poisoning is primarily supportive. Periodic tactile stimulation seems to be an effective nonpharmacological intervention to improve alpha-2 adrenergic agonist-induced central nervous system depression and respiratory depression. Intubation should be considered when tactile stimulation is not effective.

Pediatric chloral hydrate poisonings and death following outpatient procedural sedation.

INTRODUCTION: Chloral hydrate has been used medicinally since the 1800 s as a sedative hypnotic, most commonly for procedural sedation. As it is administered orally and available in a liquid formulation, it is used almost exclusively in pediatric patients despite many safer and more effective alternative agents being available. CASE SERIES: We present three cases of pediatric chloral hydrate poisoning, all occurring following procedural sedation in outpatient clinic settings and presenting to the emergency department. The ages ranged from 15 months to 4 years of age and all required resuscitation. Unfortunately, the 4-year-old died. CONCLUSION: Choral hydrate is associated with significant adverse effects, including death, and safer alternatives for pediatric procedural sedation should be sought and utilized. There are a number of more effective sedative agents with more predictable pharmacokinetic and safety profiles than chloral hydrate including parenteral and oral agents. The practice of pre-procedure sedation should be performed only in a supervised setting where cardiorespiratory monitoring can occur in all cases.

A prospective study of acute, unintentional, pediatric superwarfarin ingestions managed without decontamination.

STUDY OBJECTIVE: We determine the incidence of clinically important bleeding in children with superwarfarin rodenticide ingestions not treated with gastrointestinal decontamination or prophylactic vitamin K. METHODS: We prospectively studied patients younger than 6 years of age who reported to our poison center with acute unintentional superwarfarin ingestions. Patients who received gastrointestinal decontamination or prophylactic vitamin K were excluded. Forty-eight- to 96-hour prothrombin time or international normalized ratio (INR) blood tests were recommended, and telephone contact was attempted at least 3 days after ingestion. RESULTS: A total of 595 consecutive patients were enrolled during the 16-month study period. Fifty patients were excluded: 8 who were known to have ingested 1 pellet or less; 25 who received activated charcoal; 15 who were treated with induced emesis; and 2 who received prophylactic vitamin K. The resulting study group contained 545 patients. Eighty-two patients were lost to follow-up. Follow-up was obtained for 463 patients, including 222 by telephone contact alone, 62 by 48- to 96-hour INR, and 179 by both methods. None of the patients had clinically important coagulopathy. Two patients had an INR of 1.5 or greater (1.5 and 1.8) without symptoms. Single nosebleeds were reported in another 2 patients with normal 48-hour INRs. Another child had a small amount of blood crusted in the nose with no other symptoms and no laboratory work available. One child with a normal 48-hour INR had blood-streaked stools that were thought to be caused by an anal fissure. CONCLUSION: Children with acute unintentional superwarfarin ingestions of less than 1 box may be managed without gastric decontamination or prophylactic vitamin K. Laboratory testing for coagulopathy should be reserved for cases involving clinically evident bleeding abnormalities.