Pediatric emergency medicine trisk 3093 3093
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has been used effectively to stabilize refractory hypoglycemia at a suggested dose
of 1 to 2 µg/kg/dose every 6 to 12 hours via either an IV or subcutaneous route.
Drugs Dangerous in Small Doses
Toddlers often are brought to EDs for evaluation after possibly having ingested
one or two doses of a medication. Most often these children will be fine with little
treatment beyond reassurance. There are circumstances, however, when this
situation can be life threatening and proper intervention can be lifesaving. A large
list of chemicals and poisons can be extremely toxic in small amounts; but, this is
beyond the scope of this discussion. However, it is wise to be familiar with a
modest list of pharmaceuticals that may cause dangerous toxicity to young
children with just one or two doses ( Table 102.13 ). Many of these agents have
been discussed earlier in this chapter. The actual incidence of life-threatening
toxicity of each of these drugs, when just one or two doses have been ingested, is
as yet undefined.
A systematic approach to these patients includes a careful history, an
examination with attention to the presence of toxidromes ( Table 102.6 ), and a
guided laboratory assessment. This approach may allow narrowing of the
differential diagnosis and may allow a determination of the possible severity of
the ingestion. If the differential diagnosis includes any of the drugs listed in Table
102.13 , it may be prudent to consider decontamination and prolonged
observation. An algorithmic approach to this situation is provided in Figure
102.5 .
NONPHARMACEUTICALS
Alcohols and Glycols
CLINICAL PEARLS
