| 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). |
| Clinical features |
| Symptoms frequently appear within 1 hour of oral ingestion of pills or liquids |
| Delayed symptoms may be seen after clonidine transdermal patch exposure |
| May mimic opioid intoxication |
| Common findings: lethargy, coma, bradycardia, hypotension, respiratory depression, apnea, small pupils |
| Diagnostic evaluation |
Initial evaluation: - For patients with altered mental status: Fingerstick blood glucose
- For patients with intent of self-harm: 12-lead ECG, serum salicylate and acetaminophen levels
- Postmenarcheal females: Pregnancy test
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Symptomatic patients: As above and: - Arterial or venous pH and pCO2
- Serum electrolytes, BUN, creatinine,
- For patients with serious and persistent respiratory depression or coma: Chest radiograph
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| Treatment |
| Remove any transdermal clonidine patches |
| Support airway and breathing |
Give a trial of naloxone if respiratory depression or coma: - Opioid-naïve patients: 0.1 mg/kg IV (maximum single dose 2 mg); may repeat every 1 to 2 minutes up to 10 mg total dose
- Opioid-tolerant patients: Apneic patients: initial dose 0.2 to 1 mg, repeat if no response (maximum total dose 10 mg); if spontaneously breathing but pulse oximetry <90%, initial dose 0.04 mg IV and repeat until respiratory rate is in the normal range (maximum total dose 10 mg)
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Symptomatic bradycardia: - 1st line: Atropine, 0.02 mg/kg IV (maximum single dose: 0.5 mg), repeat after 3 to 5 minutes to maximum total dose of 0.04 mg/kg or 3 mg in adults
- 2nd line: Epinephrine 0.01 mg/kg IV bolus dose (maximum single dose 1 mg), repeat after 3 to 5 minutes or continuous infusion (for dosing refer to topics on use of vasopressors in adults and primary drugs for pediatric resuscitation)
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Hypotension: - 1st line: Crystalloid, IV normal saline or Ringer's lactate 20 mL/kg (maximum 1 L), up to 60 to 100 mL/kg (3 to 5 L) total volume
- 2nd line (rarely needed): Continuous infusion of epinephrine or similar agent (eg, norepinephrine or dopamine, for dosing refer to topics on use of vasopressors in adults and primary drugs for pediatric resuscitation)
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| Do not treat asymptomatic hypertension |
| Cutaneous decontamination: All patients with signs of potential clonidine or imidazoline poisoning warrant careful examination and removal of any adherent transdermal patches Gastrointestinal decontamination: - Alert patients who present within 1 hour of ingestion and without contraindications: Administer activated charcoal (AC), 1 gram/kg (maximum dose, 50 grams)
- Alert patients who have ingested a clonidine transdermal patch and without contraindications: Administer AC 1 gram/kg (maximum dose, 50 grams) followed by nasogastric whole bowel irrigation (WBI) at 500 mL to 1 L of polyethylene glycol (PEG) per hour
- Symptomatic patients with coma or respiratory depression who meet criteria for GI decontamination should first have their airway secured before administration of AC or WBI
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