General Approach to All Pediatric Patients

Overdose, Poisoning, or Ingestion - Pediatric

For any overdose or poisoning contact should be made with the Regional Poison Control Center. Whenever possible, determine the agent involved, the time of the ingestion/exposure, and the amount ingested. Bring empty pill bottles, etc., to the receiving facility.

Advanced Life Support

  • If any symptoms present perform Full Pediatric ALS Assessment and Treatment
  • If respiratory depression is present and an overdose is suspected:
    • Naloxone at 0.1 mg/kg (Maximum dose 2.0 mg) via IV, IO, or IM route

Treatment for specific toxic exposures is indicated only when patients are clearly symptomatic. In the absence of significant symptoms, monitor closely and expedite transport. If indicated, initiate HAZMAT Alert

Organophosphates

Symptoms include dyspnea, bronchorrhea, lacrimation, vomiting/diarrhea, weakness, paralysis, seizures

  • Atropine 0.02 mg/kg IV (minimum dose 0.1 mg)
  • If seizures present see Pediatric Seizure Protocol

Tricyclic Antidepressant

Symptoms include hypotension, arrhythmias, wide QRS complex (>0.09 sec)

  • Sodium Bicarbonate 1 mEq/kg IV
  • May be repeated in 10 minutes

Calcium Channel Blockers and Beta Blockers

Symptoms include bradycardia, hypotension and heart blocks

  • Glucagon 0.5 mg (< 20 kg) or 1 mg (≥ 20 kg) IM or IV
  • If symptoms persist, Atropine 0.02 mg/kg (minimum dose 0.1 mg)
  • If poisoning due to calcium channel blocker, Calcium Chloride 0.2 ml/kg slow IV (max 2 g)

Dystonic Reaction

Acute uncontrollable muscle contractions

  • Diphenhydramine (Benadryl) 1 mg/kg IV or deep IM (Maximum dose 50 mg)

Insulin Reaction

Hypoglycemia and altered mental status due to excessive insulin

  • Treat glucose < 70 mg/dl
    • D10W at 5 ml/kg for children < 1 year old (max 40 ml)
    • D25W at 2 ml/kg for children 1-8 years old (max 50 ml)
    • D50W at 1 ml/kg for children ≥ 9 years old (max 50 ml)
    • If no IV access Glucagon 0.5 mg (< 20 kg) or 1 mg (≥ 20 kg) IM