Toxic clonidine ingestion in children.
OBJECTIVE
We performed a prospective case series to seek dosage or clinical parameters to better identify patients who need direct medical evaluation.


METHODS
All clonidine ingestions in children younger than 12 years of age reported to 6 poison centers were followed for a minimum of 24 hours. Exclusion criterion was polydrug ingestion.


RESULTS
The study included 113 patients, of whom 63 were male. Mean age was 3.8 years (+/-2.4 SD). Clinical effects were common, but severe adverse effects occurred in <10% of patients. The dose ingested was reported for 90 patients (80%); 61 (68%) children ingested <0.3 mg and none had coma, respiratory depression, or hypotension. The lowest dose ingested by history with coma and respiratory depression was 0.3 mg (0.015 mg/kg). Prior clonidine therapy did not affect outcome. Onset of full clinical effects in all cases was complete within 4 hours of ingestion.


CONCLUSIONS
We recommend direct medical evaluation for (1) all children 4 years of age and younger with unintentional clonidine ingestion of >or=0.1 mg, (2) ingestion of >0.2 mg in children 5 to 8 years of age, and (3) ingestion of >or=0.4 mg in children older than 8 years of age. Observation for 4 hours may be sufficient to detect patients who will develop severe effects.
Spiller
Henry A
HA
Kentucky Regional Poison Center, Louisville, Kentucky 40232-5070, USA.
Klein-Schwartz
Wendy
W
Colvin
Jonathan M
JM
Villalobos
Danny
D
Johnson
Paul B
PB
Anderson
Deborah L
DL
D000700:Analgesics / Q000506:poisoning; D001919:Bradycardia / Q000139:chemically induced / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003000:Clonidine / Q000506:poisoning*; D003128:Coma / Q000139:chemically induced / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000628:therapy; D007022:Hypotension / Q000139:chemically induced / Q000628:therapy; D007035:Hypothermia / Q000139:chemically induced / Q000628:therapy; D007223:Infant; D008297:Male; D011041:Poisoning / Q000628:therapy*; D011446:Prospective Studies
D000700:Analgesics; D003000:Clonidine