Pediatric Medicine

Answer 1 Administer naloxone 0.1 mg/kg body weight intravenously with close cardiovascular monitoring. This child ingested his grandfather’s blood pressure medicine. Clonidine is an antihypertensive agent that exerts its effect through stimulation of alpha2-adrenergic receptors. It is an extremely potent drug, with typical doses of 0.1 to 0.2 mg in adults. Therefore, ingestion of small amounts can potentially lead to significant toxicity in children. Clonidine has excellent central nervous system (CNS) penetration because of high lipid solubility. Clinical features suggestive of clonidine ingestion include lethargy, apnea, bradycardia, profound hypotension, and miosis. The treatment requires immediate assessment and management of the patients airway, breathing, and circulation. Gastrointestinal (GI) decontamination may be ineffective 2 hours after ingestion, because clonidine is rapidly absorbed from the GI tract. Therapy or maneuvers that cause emesis also should be avoided in this child, because they can cause aspiration. Even placement of a nasogastric tube should not be performed in a comatose child before intubating the child. Naloxone has been suggested as a specific antidote for clonidine overdose and often may improve mental status and cardiorespiratory function. Click here to return to the questions

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