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Accidental Poisoning With Psychotropic Drugs in Children FREE

David J. Greenblatt, MD; Marcia D. Allen, RN; Jan Koch-Weser, MD; Richard I. Shader, MD
[+] Author Affiliations

Received for publication Jan 27,1975; accepted April 15.

Reprint requests to the Clinical Pharmacology Unit, Massachusetts General Hospital, Boston, MA 02114 (Dr Greenblatt).


Am J Dis Child. 1976;130(5):507-511. doi:10.1001/archpedi.1976.02120060053010.
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• Seventy-seven (0.24%) of 32,005 admissions to the Massachusetts General Hospital pediatric service during the period 1962 to 1973 were due to accidental poisoning. In 27 cases, mostly involving children less than 6 years of age, psychotropic drugs were implicated. These included sedative-hypnotics in six cases, phenytoin in two, major tranquilizers in five, antidepressants in three, stimulants or hallucinogens in three, and drug mixtures in eight. Toxicologic analyses contributed little to diagnosis and initial management. Except for one child who ingested ferrous sulfate, no patient was seriously intoxicated, and all recovered rapidly without sequelae. Although referral of serious poisoning cases to another hospital may have biased the results, the findings suggest that accidental psychotropic drug poisoning is not a major source of childhood morbidity.

(Am J Dis Child 130:507-511, 1976)

REFERENCES

Bean P:  Patterns of self poisoning . Br J Prev Soc Med 28:24-31, 1974;.
Sharman JR, Taylor HW, Scott RD:  Drug overdosages and poisonings in Christchurch during 1971 . NZ Med J 76:402-404, 1972;.
Sims M, Purdy M, Devenyi P:  Drug overdoses in a Canadian city . Am J Public Health 63:215-226, 1973;.
Link to Article
Davis JM, Bartlett E, Termini BA:  Overdosage of psychotropic drugs: A review . Dis Nerv Syst 29:157-164, 246-256, 1968;.
Hancock BW:  Accidental poisoning in childhood . Br J Clin Prac 27:77-80, 1973;.
Matthew H, Lawson AAH:  Acute barbiturate poisoning: A review of two years experi ence . Q J Med 35:539-552, 1966;.
Berry DJ, Grove J:  Emergency toxicological screening for drugs commonly taken in overdose . J Chromatogr 80:205-219, 1973;.
Link to Article
Finkle BS, Foltz RL, Taylor DM:  A comprehensive GC-MS reference data system for toxicological and biomedical purposes . J Chromatogr Sci 12:304-328, 1974;.
Link to Article
Cravey RH, Jain NC:  The identification of non-barbiturate hypnotics from biological specimens . J Chromatogr Sci 12:237-245, 1974;.
Link to Article
Garriott JC, Stolman A:  Detection of some psychotherapeutic drugs and their metabolites in urine . Clin Toxicol 4:225-243, 1971;.
Link to Article
Jatlow P, Seligson D:  Application of a digital computer to emergency toxicology . Clin Chim Acta 50:19-30, 1974;.
Link to Article
Greenblatt DJ, Shader RI: Benzodiazepines in Clinical Practice . New York, Raven Press, 1974;, pp 275-276.
Lundberg GD, Walberg CB, Pantlik VA:  Frequency of clinical toxicology test-ordering (primarily overdose cases) and results in a large urban general hospital . Clin Chem 20:121-125, 1974;.
King JS (ed):  Are emergency toxicology measurements really used? Clin Chem 20:116-120, 1974;.
Sellers EM:  Factors influencing the interpretation of drug concentration in acute drug overdose , in Sellers EM (ed): Clinical Pharmacology of Psychoactive Drugs . Toronto, Addiction Research Foundation of Ontario, 1975;, pp 73-86.
Scherz RG (ed):  The management of accidental childhood poisoning . Pediatrics 54:324-356, 1974;.
Arena JM:  General principles of treatment and specific antidotes . Mod Treat 8:461-502, 1971;.
Masoud AN, Elder JT, Czerwinski AL:  Chemistry and pharmacology of common acute poisoning in childhood . Paediatrician 2:2-37, 1973;.
DeCastro FJ:  Principles of emergency treatment of poisoning in childhood . Paediatri cian 2:47-59, 1973;.
Teitelbaum DT:  Poisoning with psychoactive drugs . Pediatr Clin North Am 17:557-567, 1970;.
Done AK:  Acute barbiturate poisoning in children , in Matthew H (ed): Acute Barbiturate Poisoning . Amsterdam, Excerpta Medica, 1971;, pp 255-262.
Greenblatt DJ, Shader RI:  Psychotropic drug overdosage , in Shader RI (ed): Manual of Psychiatric Therapeutics . Boston, Little Brown & Co, 1975;, pp 237-267.
Greenblatt DJ, Shader RI:  Rational use of psychotropic drugs: III. Major tranquilizers . Am J Hosp Pharm 31:1226-1231, 1974;.
Parkin JM, Fraser MS:  Poisoning as a complication of enuresis . Dev Med Child Neurol 14:727-730, 1972;.
Link to Article
Sesso AM, Snyder RC, Schott CE:  Propranolol in imipramine poisoning . Am J Dis Child 126:847-849, 1973;.
Ruddy JM, Seymour JL, Anderson NG:  Management of tricyclic antidepressant ingestion in children with special reference to the use of glucagon . Med J Aust 1:630-633, 1972;.
Sunshine P, Yaffee SJ:  Amitriptyline poisoning . Am J Dis Child 106:501-506, 1963;.
Roberts RJ, Mueller S, Lauer RM:  Propranolol in the treatment of cardiac arrhythmias associated with amitriptyline intoxication . J Pediatr 82:65-67, 1973;.
Link to Article
Sueblinvong V, Wilson JF:  Myocardial damage due to imipramine intoxication . J Pediatr 74:475-478, 1969;.
Link to Article
Fouron J-C, Chicoine R:  ECG changes in fatal imipramine (Tofranil) intoxication . Pediatrics 48:777-781, 1971;.
Young JA, Galloway WH:  Treatment of severe imipramine poisoning . Arch Dis Child 46:353-355, 1971;.
Link to Article
Kanarek KS, Thompson PD, Levin SE:  The management of severe imipramine (Tofranil) intoxication in children . S Afr Med J 47:835-838, 1973;.
Goel KM, Shanks RA:  Amitriptyline and imipramine poisoning in children . Br Med J 1:261-263, 1974;.
Link to Article
Brown TCK, Dwyer ME, Stocks JG:  Antidepressant overdosage in children: A new menace . Med J Aust 2:848-851, 1971;.
Shader RI, Greenblatt DJ:  Belladonna alkaloids and synthetic anticholinergics: Uses and toxicity , in Shader RI (ed): Psychiatric Complications of Medical Drugs . New York, Raven Press, 1972;, pp 103-147.
Greenblatt DJ, Shader RI:  Drug therapy: Anticholinergics . N Engl J Med 288:1215-1219, 1973;.
Link to Article

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References

Bean P:  Patterns of self poisoning . Br J Prev Soc Med 28:24-31, 1974;.
Sharman JR, Taylor HW, Scott RD:  Drug overdosages and poisonings in Christchurch during 1971 . NZ Med J 76:402-404, 1972;.
Sims M, Purdy M, Devenyi P:  Drug overdoses in a Canadian city . Am J Public Health 63:215-226, 1973;.
Link to Article
Davis JM, Bartlett E, Termini BA:  Overdosage of psychotropic drugs: A review . Dis Nerv Syst 29:157-164, 246-256, 1968;.
Hancock BW:  Accidental poisoning in childhood . Br J Clin Prac 27:77-80, 1973;.
Matthew H, Lawson AAH:  Acute barbiturate poisoning: A review of two years experi ence . Q J Med 35:539-552, 1966;.
Berry DJ, Grove J:  Emergency toxicological screening for drugs commonly taken in overdose . J Chromatogr 80:205-219, 1973;.
Link to Article
Finkle BS, Foltz RL, Taylor DM:  A comprehensive GC-MS reference data system for toxicological and biomedical purposes . J Chromatogr Sci 12:304-328, 1974;.
Link to Article
Cravey RH, Jain NC:  The identification of non-barbiturate hypnotics from biological specimens . J Chromatogr Sci 12:237-245, 1974;.
Link to Article
Garriott JC, Stolman A:  Detection of some psychotherapeutic drugs and their metabolites in urine . Clin Toxicol 4:225-243, 1971;.
Link to Article
Jatlow P, Seligson D:  Application of a digital computer to emergency toxicology . Clin Chim Acta 50:19-30, 1974;.
Link to Article
Greenblatt DJ, Shader RI: Benzodiazepines in Clinical Practice . New York, Raven Press, 1974;, pp 275-276.
Lundberg GD, Walberg CB, Pantlik VA:  Frequency of clinical toxicology test-ordering (primarily overdose cases) and results in a large urban general hospital . Clin Chem 20:121-125, 1974;.
King JS (ed):  Are emergency toxicology measurements really used? Clin Chem 20:116-120, 1974;.
Sellers EM:  Factors influencing the interpretation of drug concentration in acute drug overdose , in Sellers EM (ed): Clinical Pharmacology of Psychoactive Drugs . Toronto, Addiction Research Foundation of Ontario, 1975;, pp 73-86.
Scherz RG (ed):  The management of accidental childhood poisoning . Pediatrics 54:324-356, 1974;.
Arena JM:  General principles of treatment and specific antidotes . Mod Treat 8:461-502, 1971;.
Masoud AN, Elder JT, Czerwinski AL:  Chemistry and pharmacology of common acute poisoning in childhood . Paediatrician 2:2-37, 1973;.
DeCastro FJ:  Principles of emergency treatment of poisoning in childhood . Paediatri cian 2:47-59, 1973;.
Teitelbaum DT:  Poisoning with psychoactive drugs . Pediatr Clin North Am 17:557-567, 1970;.
Done AK:  Acute barbiturate poisoning in children , in Matthew H (ed): Acute Barbiturate Poisoning . Amsterdam, Excerpta Medica, 1971;, pp 255-262.
Greenblatt DJ, Shader RI:  Psychotropic drug overdosage , in Shader RI (ed): Manual of Psychiatric Therapeutics . Boston, Little Brown & Co, 1975;, pp 237-267.
Greenblatt DJ, Shader RI:  Rational use of psychotropic drugs: III. Major tranquilizers . Am J Hosp Pharm 31:1226-1231, 1974;.
Parkin JM, Fraser MS:  Poisoning as a complication of enuresis . Dev Med Child Neurol 14:727-730, 1972;.
Link to Article
Sesso AM, Snyder RC, Schott CE:  Propranolol in imipramine poisoning . Am J Dis Child 126:847-849, 1973;.
Ruddy JM, Seymour JL, Anderson NG:  Management of tricyclic antidepressant ingestion in children with special reference to the use of glucagon . Med J Aust 1:630-633, 1972;.
Sunshine P, Yaffee SJ:  Amitriptyline poisoning . Am J Dis Child 106:501-506, 1963;.
Roberts RJ, Mueller S, Lauer RM:  Propranolol in the treatment of cardiac arrhythmias associated with amitriptyline intoxication . J Pediatr 82:65-67, 1973;.
Link to Article
Sueblinvong V, Wilson JF:  Myocardial damage due to imipramine intoxication . J Pediatr 74:475-478, 1969;.
Link to Article
Fouron J-C, Chicoine R:  ECG changes in fatal imipramine (Tofranil) intoxication . Pediatrics 48:777-781, 1971;.
Young JA, Galloway WH:  Treatment of severe imipramine poisoning . Arch Dis Child 46:353-355, 1971;.
Link to Article
Kanarek KS, Thompson PD, Levin SE:  The management of severe imipramine (Tofranil) intoxication in children . S Afr Med J 47:835-838, 1973;.
Goel KM, Shanks RA:  Amitriptyline and imipramine poisoning in children . Br Med J 1:261-263, 1974;.
Link to Article
Brown TCK, Dwyer ME, Stocks JG:  Antidepressant overdosage in children: A new menace . Med J Aust 2:848-851, 1971;.
Shader RI, Greenblatt DJ:  Belladonna alkaloids and synthetic anticholinergics: Uses and toxicity , in Shader RI (ed): Psychiatric Complications of Medical Drugs . New York, Raven Press, 1972;, pp 103-147.
Greenblatt DJ, Shader RI:  Drug therapy: Anticholinergics . N Engl J Med 288:1215-1219, 1973;.
Link to Article

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