title: Pediatric poisoning from trimedoxime (TMB4) and atropine automatic injectors.
abstract: OBJECTIVE
  To describe the effects of combined trimedoxime (TMB4) and atropine poisoning from automatic injectors (AI) in children.
  
  
  METHODS
  Data was collected from two sources: calls to the Israel Poison Information Center (IPIC) during a 1-year period and a cohort of children who presented to pediatric emergency departments (EDs) after unintentional injection of an AI. Demographic data and data regarding the type of AI, site and time of injection, and the clinical manifestations were abstracted.
  
  
  RESULTS
  Data were available for 142 patients. The median age was 8.5 years (range 1.25-18 years). The dose of atropine and TMB4 was higher than the recommended dose for age in 22 (15.5%) cases. There were few side effects attributable to atropine: dilated pupils (26.7%), dryness of mucous membranes (24.6%), and tachycardia (22.5%). Compared with children injected with an age-appropriate dose, children injected with an AI that contained a dose that exceeds the recommended one were more likely to be symptomatic ( P = .029). There were no side effects characteristic to oximes, and no specific medical intervention was required.
  
  
  CONCLUSIONS
  Unintentional pediatric atropine and TMB4 injection, even an adult dose in a small child, does not cause significant side effects.
authors.affiliation: Sakler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. erank@asaf.health.gov.il
authors.forename: Eran
authors.initials: E
authors.lastname: Kozer
authors.forename: Amnon
authors.initials: A
authors.lastname: Mordel
authors.forename: Shmuael Bar
authors.initials: SB
authors.lastname: Haim
authors.forename: Mordechei
authors.initials: M
authors.lastname: Bulkowstein
authors.forename: Matitiahu
authors.initials: M
authors.lastname: Berkovitch
authors.forename: Yedidia
authors.initials: Y
authors.lastname: Bentur
mesh_terms: D000293:Adolescent; D000931:Antidotes / Q000008:administration & dosage / Q000506:poisoning*; D001285:Atropine / Q000008:administration & dosage / Q000506:poisoning*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D007267:Injections / Q000295:instrumentation*; D008297:Male; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000506:poisoning*; D011041:Poisoning / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D014289:Trimedoxime / Q000008:administration & dosage / Q000506:poisoning*
chemical_list: D000931:Antidotes; D018727:Muscarinic Antagonists; D014289:Trimedoxime; D001285:Atropine