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A 3-year-old boy is brought to the emergency department by emergency medical services (EMS) after he was found to be unresponsive at his grandmother™s home. The grandmother reports finding near the child an empty plastic bag, in which she used to keep her blood pressure (BP) medications. The child is hypotensive, bradycardic, apneic, and has pinpoint pupils. After securing an airway, which of the following therapies may be beneficial?
A. Cardioversion
B. High-dose insulin
C. Glucagon (GlucaGen)
D. Naloxone HCl (Narcan)
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D.
Clonidine is a central alpha-adrenergic agonist used to reduce BP and slow the heart rate by decreasing sympathetic stimulation. Clonidine toxicity is manifested by altered mental status, hypotension, bradycardia, miosis, and respiratory depression. Many times, supportive therapies for clonidine toxicity, such as gastric lavage, whole-bowel irrigation, and IV fluid administration are effective. Vasopressors and alpha agonists may be required to raise BP and heart rate. Naloxone has been shown to improve the mental status of adults and children who have ingested toxic amounts. The American Academy of Pediatrics recommends a dose of 0.1 mg/kg for children up to 5 years old or those who weigh less than 20 kg. For children 5 years and older or those who weigh 20 kg or more, the minimum dose is 2 mg. Although the patient is hypotensive, he is bradycardic, and cardioversion will not help. High-dose insulin is used for calcium channel blocker toxicity and glucagon for beta-blocker toxicity. Although these antihypertensive agents can certainly cause hypotension and bradycardia, they will not produce the miosis and respiratory depression seen in this case.
