title: Use of naloxone for clonidine intoxication in the pediatric age group: case report and review of the literature.
abstract: The incidence of clonidine overdose is increasing worldwide, possibly because of the broadening of indications to include several psychiatric conditions, yet there is a paucity of new information regarding treatment options for clonidine toxicity. We report a case in whom naloxone was used and discuss the literature on this topic. A 2-year-old male infant presented with a history of lethargy. Vital signs were notable for hypotension, pupillary constriction, and hypotonia. The Glasgow Coma score progressively worsened, precipitating intubation. Naloxone was given without response. Urine toxicology revealed high concentrations of clonidine but no opiates. Rapid boluses of isotonic crystalloids and intravenous atropine 0.02 mg/kg were administered with good response. The patient was subsequently discharged home with pediatric and community services follow-up. The use of naloxone in the treatment of clonidine intoxication is unclear, and empirical use does not seem to be justified.
authors.affiliation: 1Department of Emergency Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia; 2Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; 3Division of Neonatal and Pediatric Emergency Medicine, Synergy Neonatal and Pediatric Hospital, Ahmedabad, India; 4Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital; and 5Division of Clinical Pharmacology and Toxicology, Ichilov Hospital, University of Tel Aviv, Tel Aviv, Israel.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.forename: Dennis
authors.initials: D
authors.lastname: Scolnik
authors.forename: Vala
authors.initials: V
authors.lastname: Snehal
authors.forename: Miguel
authors.initials: M
authors.lastname: Glatstein
mesh_terms: D000931:Antidotes / Q000627:therapeutic use; D001285:Atropine / Q000627:therapeutic use*; D002675:Child, Preschool; D003000:Clonidine / Q000506:poisoning*; D000077324:Crystalloid Solutions; D062787:Drug Overdose; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000931:Antidotes; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D009292:Narcotic Antagonists; D009270:Naloxone; D001285:Atropine; D003000:Clonidine