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ClinicalToxExpertPeerReviewStamp2x200Clinical Toxicology has published guidelines for out-of-hospital management of 16 distinct overdoses and their dose thresholds, above which, pediatric patients should be referred to the Emergency Department for evaluation. Clinical Toxicology is the official journal of the American Academy of Clinical Toxicology (AACT, @AACTinfo), the American Association of Poison Control Centers (AAPCC, @AAPCC), and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT). AACT has a link to each guideline on its website. There are two caveats to be aware of regarding these guidelines.

  1. They were developed between 2005 and 2007. New medications have been approved since that time and there may be more recent data available.
  2. As with any poisoning, dose is only one factor when determining disposition. Consideration should also be given to intent, underlying medical conditions, co-ingestion of other medications, presence of symptoms, and drug formulation.

This PV Card summarizes the pediatric ingestion dose thresholds for referral to an ED.

Pediatric Dose Thresholds

Pediatric Dose1

Pediatric Dose2

The reference URL links (right column) work if you download the PDF.

You can download this PV card [PDF]
See other Paucis Verbis cards.

Thanks to Zlatan Coralic, PharmD (@ZEDPharm) for his excellently detailed expert peer review and suggestions for revisions for this important card.

 

References

  1. Dart RC, et al; American Association of Poison Control Centers. Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(1):1-18. PubMed PMID: 16496488.
  2. Cobaugh DJ, et al. Atypical antipsychotic medication poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007 Dec;45(8):918-42. PubMed PMID: 18163235.
  3. Caravati EM, et al. Long-acting anticoagulant rodenticide poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(1):1-22.  PubMed PMID: 17357377.
  4. Wax PM, et al. Beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(3):131-46. PubMed PMID: 15906457.
  5. Olson KR, et al; American Association of Poison Control Centers. Calcium channel blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(7):797-822. PubMed PMID: 16440509.
  6. Manoguerra AS, et al; American Association of Poison Control Centers. Camphor Poisoning: an evidence-based practice guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(4):357-70. PubMed PMID: 16809137.
  7. Chyka PA, et al; American Association of Poison Control Centers. Dextromethorphan poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007 Sep;45(6):662-77. PubMed PMID: 17849242.
  8. Scharman EJ, et al. Diphenhydramine and dimenhydrinate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(3):205-23. PubMed PMID: 16749537.
  9. Caravati EM, et al; American Association of Poison Control Centers. Ethylene glycol exposure: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(5):327-45. PubMed PMID: 16235508.
  10. Manoguerra AS, et al. Iron ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(6):553-70. PubMed PMID: 16255338.
  11. Caravati EM, et al; American Association of Poison Control Centers. Elemental mercury exposure: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2008 Jan;46(1):1-21. doi: 10.1080/15563650701664731. PubMed PMID: 18167033.
  12. Scharman EJ, et al; American Association of Poison Control Centers. Methylphenidate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007 Oct-Nov;45(7):737-52. PubMed PMID: 18058301.
  13. Chyka PA, et al; American Association of Poison Control Centers; Healthcare Systems Bureau, Health Resources and Services Administration, Department of Health and Human Services. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131. PubMed PMID: 17364628.
  14. Nelson LS, et al. Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007 May;45(4):315-32. PubMed PMID: 17486478.
  15. Woolf AD, et al. Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(3):203-33. PubMed PMID: 17453872.
  16. Manoguerra AS, et al; American Association of Poison Control Centers. Valproic acid poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2008 Aug;46(7):661-76. doi: 10.1080/15563650802178136. PubMed PMID: 18608263

 

Bryan D. Hayes, PharmD, FAACT

Bryan D. Hayes, PharmD, FAACT

ALiEM Associate Editor
Clinical Assistant Professor, University of Maryland (UM)
Clinical Pharmacy Specialist, EM and Toxicology
Bryan D. Hayes, PharmD, FAACT

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