Pediatric emergency medicine trisk 3090 3090
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usually the result of uncontrolled seizures that progress to coma and
cardiorespiratory arrest.
The treatment of antihistamine poisoning requires an accurate history of the
time of ingestion and the type and quantity of drug consumed. Of particular
importance is the type of drug ingested because numerous sustained-release
antihistamine products are available. Options for GI decontamination include the
use of activated charcoal, and overdoses with the sustained-release preparations
may benefit from WBI.
Patients with seizures (see Chapters 72 Seizures and 97 Neurologic
Emergencies ) require anticonvulsant therapy immediately. Preferably, short-term
control may be gained by using a benzodiazepine. Of the three commonly used
benzodiazepines, midazolam has the shortest duration of sedation and thus may
be preferred in this setting. Administer 0.1 mg/kg IV (max 5 mg) or 0.2 mg/kg IM
(max 10 mg) and repeat the dose in 5 minutes if convulsions do not stop. Severely
agitated patients with a clear anticholinergic toxidrome may have improved
sensorium after administration of physostigmine. This is usually administered in
an initial dose of 0.02 mg/kg (not to exceed 0.5 mg/dose) IV slowly over 3
minutes. The dose may be repeated every 10 to 15 minutes (adult max 2 mg) to
establish the effective total dose. The minimal effective dose may be repeated in
several hours, if necessary. It should be noted that when administered too rapidly
or in too large of a dose, physostigmine might precipitate seizures or asystole.
Physostigmine would be particularly dangerous to use in the context of any
coingestants that might affect intracardiac conduction, such as tricyclic
antidepressants. A 12-lead EKG should be examined for conduction delays before
physostigmine is given. Cardiac rhythm should be monitored closely during
antidote infusion, and atropine should be available to reverse severe cholinergic
effects that may also occur with physostigmine use. The potential risks
encountered with physostigmine may favor use of a benzodiazepine for treatment
of anticholinergic delirium.
Meticulous attention to supportive care is critical. Some patients may develop
extreme hyperthermia and thus require aggressive measures to reduce core body
temperature, including ice water baths or misting and fans. There is little evidence
for therapeutic efficacy of dialysis or hemoperfusion because of the high plasma
protein binding and large volumes of distribution for most of these agents.
Isoniazid
Current Evidence. INH is an important treatment for tuberculosis. Even when
taken appropriately, INH has many actions that can lead to clinical toxicity. These
