Increasing childhood drug poisonings

• Use child-resistant packaging. Replace caps tightly after use.

• Lock all medicines up high, out of sight and reach of children.

• Take medicines when children aren’t looking, because children will imitate adults taking medicines.

• Be sure that all family members and visitors are vigilant about locking up their medicines.

• Take special care when traveling to be sure that medicines are locked away from children.

Case 1: A 2-year-old girl drank some juice which she said made her tongue feel "weird". Then she took a nap. When she was found, she was limp and cold. Her breathing, heart rate, and blood pressure were extremely low. In the emergency room, a breathing tube was put in. She was given naloxone, a drug to treat narcotic overdoses, because her symptoms were like a narcotic overdose. By the next day, brain damage was confirmed. She was declared brain dead after six days; she died the day after.

It was later learned that the juice had been mixed with methadone, a narcotic drug. Methadone is used as a pain reliever and to treat people with heroin addiction. While it is often mixed with juice, it is never safe to store it where children – or anyone to whom it's not prescribed – can make a mistake with it.

Reference: Bronstein AC, Spyker DA, Cantilena LR Jr. Ruamck BH, Dart RC. 2011 Annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 29th annual report. Clinical Toxicology. 2012;50:911–1164.

Case 2: A 1-year-old boy got into a bottle of clonidine 0.1 mg that had been left out on a dresser. (Clonidine is a drug used to control high blood pressure and also for treatment of attention deficit hyperactive disorder in children.) His mom called 911, who conferenced with a poison center. She reported that the child’s breathing was changing. The poison center recommended naloxone (a drug that can reverse depressed breathing in narcotic poisoning but may also be useful with clonidine) if the child's breathing rate was low. On arrival to the emergency room he was extremely drowsy and responsive only to stimulation such as shaking him or loud voices. His blood pressure (BP) and heart rate (HR) were low. He had not required naloxone but was placed on intravenous (IV) fluids and oxygen.

The emergency physician consulted a poison center and was advised to admit the child to the hospital on a cardiac monitor, at least overnight. The little boy was admitted to pediatric intensive care. Four hours after the child got into the clonidine, he remained very sleepy but would cry and fuss when stimulated. He was breathing well off oxygen but remained on IV fluids. His HR remained slightly low for a child his age. Seventeen hours after the clonidine ingestion, the child was lethargic but appropriately upset when touched by his nurses. His BP and HR were normal  He was taking oral fluids well and was sent home later that day.