Version May 2024
To obtain emergency consultation with a clinical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links).
This algorithm is intended for patients who ingest a potentially toxic dose of a clonidine or chemically-related imidazoline preparation (refer to inset table). No minimum toxic dose of clonidine has been established. Any clonidine or related imidazoline ingestion in a young child is potentially poisonous and requires emergency evaluation. Signs of clonidine or related imidazoline toxicity after ingestion include lethargy, coma, miosis, depressed respirations, apnea, bradycardia, hypotension, and/or transient hypertension. All such patients also should undergo a complete examination of the skin, palate, anus, and genitalia for adherent transdermal clonidine patches. For more information on diagnosis and treatment, refer to UpToDate content on clonidine and related imidazoline poisoning.
This algorithm should be used in conjunction with additional UpToDate content. For additional details, including the evidence supporting the efficacy of these treatments, refer to UpToDate topics on clonidine and related imidazoline poisoning.AC: activated charcoal; WBI: whole bowel irrigation.
* Because of the large potential ingested dose and the risk of delayed absorption, AC may be administered beyond 1 hour after transdermal patch ingestion. Children who have low dose ingestions (eg, 1 tablet or 1 swallow of liquid) can have serious toxicity soon after ingestion. Some experts withhold AC in these situations because AC is unlikely to prevent poisoning and may pose a significant aspiration risk if coma develops during administration.
¶ Safe administration of WBI requires careful assessment of mental status and breathing, a functioning GI tract (soft, nontender, nondistended, and with bowel sounds on examination), confirmation of NG tube position, and proper positioning during administration. Refer to UpToDate topics on WBI for details.
Δ Patients who do not have opioid tolerance may require high doses of naloxone up to a total dose of 10 mg to achieve reversal. Because the benefit of naloxone in patients with clonidine or related imidazoline poisoning is uncertain, some experts do not routinely use naloxone in this setting, especially in adults. For naloxone dosing, refer to UpToDate content on management of clonidine and related imidazoline poisoning.
◊ Fluid volume and rate varies by age and comorbidities. For the rare patient who has persistent shock refractory to correction of symptomatic bradycardia and fluid resuscitation, start a continuous infusion of epinephrine or other agents such as norepinephrine or dopamine.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
