Are One or Two Dangerous? Calcium Channel Blocker Exposure in Toddlers

Ranniger, Claudia; Roche, Colleen

doi:10.1016/j.jemermed.2007.02.010

Cited by 34 publications

(34 citation statements)

References 60 publications

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“…18 Although classically the great majority of toxic exposures affecting children up to the age of 6 years are unintentional and of low toxicity, 18,19 swallowing just two pills of a calcium channel blocker such as nifedipine or amlodipine, for example, can cause serious morbidity and, occasionally, death at this age, indicating the risk generated by lack of concern for the safe storage of these medications. 20 In general the quantities of pharmaceutical preparations stored followed the same ranking as in a previous study in which we compared use of medications due to self-medication or recent medical prescription, 13 suggesting that keeping medicines at home could be one extra factor inducing self-medication, 11 particularly of analgesics/antipyretics and antibiotics for systemic use. 4,5,[8][9][10] Furthermore, the quantity of acetylsalicylic acid stored by the self-medication group was 10 times greater than the quantity stored by the medical prescription group, indicating that this medicine is probably not bought on the basis of medical advice.…”

Section: Discussionmentioning

confidence: 99%

Farmácias domiciliares e sua relação com a automedicação em crianças e adolescentes

Tourinho¹,

Bucaretchi²,

Stephan³

et al. 2008

J. Pediatr. (Rio J.)

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Objective: To investigate the contents of home medicine chests and their relationship with self-medication in children and adolescents in the towns of Limeira and Piracicaba, SP, Brazil.Methods: This is a descriptive population study based on a home survey of a simple random sample from both towns, comprising 705 households from census sectors selected by means of cluster sampling. Inclusion criteria: age ≤ 18 years; an obligatory interview with at least one guardian; inventory of medicines kept at home; and having taken at least one medication during the 15 days prior to the interview. The participants were split into two groups based on medication: self-medication (lay advice) and medical prescription. Tests of linear association were performed, in addition to a descriptive analysis of the variables and multiple logistic regression.Results: A total of 3,619 medicines were found (mean = 5.1/household; 79.6% were pharmaceutical preparations).The rooms most commonly used to store medications were bedrooms (47.5%), kitchens (29.9%), and bathrooms (14.6%); 76.5% were in cardboard boxes and within easy reach of 142 children aged ≤ 6 years. Taking the pharmaceutical preparations in isolation (n = 2,891), the most common were analgesics/antipyretics (26.8%) and systemic antibiotics (15.3%), and the self-medication group had significantly larger stocks of these medications (p < 0.01). Storing medications in the bathroom (odds ratios = 1.59) and legal guardians with ≤ 4 years of primary education (odds ratios = 2.40) indicated greater risk of self-medication. Conclusions:Keeping medicines at home is a common practice, and it is important to implement campaigns to encourage rational use, reduced waste and safe storage of medicines.

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Section: Discussionmentioning

confidence: 99%

Farmácias domiciliares e sua relação com a automedicação em crianças e adolescentes

Tourinho¹,

Bucaretchi²,

Stephan³

et al. 2008

J. Pediatr. (Rio J.)

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“…Thirteen of these single-agent exposures resulted in death, and 28% involved children younger than 6 years of age (1). Children could be at particular risk of poisoning from calcium channel blockers due to the high dosage form strength in comparison to body weight (2,3). A single 10-mg nifedipine tablet was associated with the death of an infant (4).…”

Section: Introductionmentioning

confidence: 99%

Amlodipine Toxicity in Children Less Than 6 Years of Age: A Dose-Response Analysis Using National Poison Data System Data

Benson

Spyker

Troutman

et al. 2010

The Journal of Emergency Medicine

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“…2 All classes of CCBs can cause hyperglycemia by binding L-type calcium channels on pancreatic β-islet cells, which inhibits insulin release, as well as by altering tissue insulin sensitivity. 3 This can lead to decreased free fatty acid utilization by the myocardium and can result in lactic acidosis and depressed cardiac contractility.…”

Section: Discussionmentioning

confidence: 99%

Acute Onset of Multi-Organ System Dysfunction

Zimmerman

Frieberg

DeBord

et al. 2011

Clin Pediatr (Phila)

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A 7-year-old boy with no significant past medical history was transported to an outside emergency department by emergency medical services after multiple episodes of emesis followed by a witnessed 10-minute episode of "shaking all over." In the emergency department, the patient was found to be profoundly acidotic with an arterial pH of 6.9, bradycardic (heart rate 50 beats/min), hypotensive (blood pressure 69/28 mm Hg), and hyperglycemic (serum glucose of 305 mg/dL). A preliminary diagnosis of diabetic ketoacidosis was established. Therapy was initiated with dextrose-containing intravenous fluids and a regular insulin drip. Following initial interventions targeted at stabilization of the patient's condition, he was transferred to our pediatric intensive care unit for further evaluation and management. On arrival, the patient's adoptive mother reported that he had been well-appearing up until shortly before the emesis began, when he became tired and sluggish. She denied any recent illnesses, fevers, sick contacts, or possible ingestions. The only medications reported to be in the home were aspirin, metformin, and prenatal vitamins.Physical exam revealed a well-developed boy who was drowsy and irritable. Vital signs included a temperature of 99°F, heart rate of 82 beats/min, blood pressure of 78/57 mm Hg, respiratory rate of 40 breaths/min, and oxygen saturation of 100% on room air. Pupils were equal and reactive and mucous membranes were dry. Cardiac exam was significant for bradycardia with strong pulses and normal capillary refill. Abdominal exam was benign. Neurologic exam was notable for a Glasgow Coma Score of 14 secondary to confusion; reflexes, motor, and sensory exams were unremarkable. Laboratory evaluation revealed negative serum and urine ketones, metabolic acidosis with arterial pH of 7.156, anion gap of 19, lactic acid of 10 mmol/L, serum glucose of 159 mg/dL, sodium 143 mmol/L, bicarbonate 14 mmol/L, potassium 4.1 mmol/L, magnesium 2.3 mg/dL, creatinine of 2.3 mg/dL, serum osmolarity of 301 mosm/kg, and negative urinary toxicology screen. Cerebrospinal fluid analysis was unremarkable. Electrocardiogram revealed junctional rhythm with a rate of 78 beats/min (Figure 1). Echocardiogram revealed normal anatomy and biventricular function. The patient was started on intravenous ceftriaxone and dopamine infusion at 5 µg/ kg/min to maintain systemic blood pressure.The patient's mental status deteriorated over the several hours following admission, requiring elective intubation and mechanical ventilation. Persistence of hypotension and onset of oliguria necessitated increasing doses of dopamine and the addition of intravenous norepinephrine at 0.01 µg/kg/min. After a period of 18 hours following admission, as infectious or cardiac causes of the patient's shock became increasingly unlikely, mass spectrometry of the urine was performed in the search for a toxic cause. Urine mass spectrometry revealed diltiazem, a calcium channel blocker (CCB). Final DiagnosisDiltiazem ingestion resulting in bradycardia, hypoten...

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Are One or Two Dangerous? Calcium Channel Blocker Exposure in Toddlers

Cited by 34 publications

References 60 publications

Farmácias domiciliares e sua relação com a automedicação em crianças e adolescentes

Farmácias domiciliares e sua relação com a automedicação em crianças e adolescentes

Amlodipine Toxicity in Children Less Than 6 Years of Age: A Dose-Response Analysis Using National Poison Data System Data

Acute Onset of Multi-Organ System Dysfunction

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