ExpertPeerReviewStamp2x200Clinical 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


Adapted from 1–16
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.

1.
Wax P, Erdman A, Chyka P, et al. beta-blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(3):131-146. [PubMed]
2.
Caravati E, Erdman A, Christianson G, et al. Ethylene glycol exposure: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(5):327-345. [PubMed]
3.
Manoguerra A, Erdman A, Booze L, et al. Iron ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(6):553-570. [PubMed]
4.
Olson K, Erdman A, Woolf A, et al. Calcium channel blocker ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(7):797-822. [PubMed]
5.
Dart R, Erdman A, Olson K, et al. Acetaminophen poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(1):1-18. [PubMed]
6.
Scharman E, Erdman A, Wax P, et al. Diphenhydramine and dimenhydrinate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(3):205-223. [PubMed]
7.
Manoguerra A, Erdman A, Wax P, et al. Camphor Poisoning: an evidence-based practice guideline for out-of-hospital management. Clin Toxicol (Phila). 2006;44(4):357-370. [PubMed]
8.
Caravati E, Erdman A, Scharman E, 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]
9.
Chyka P, Erdman A, Christianson G, et al. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131. [PubMed]
10.
Woolf A, Erdman A, Nelson L, et al. Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(3):203-233. [PubMed]
11.
Nelson L, Erdman A, Booze L, et al. Selective serotonin reuptake inhibitor poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(4):315-332. [PubMed]
12.
Chyka P, Erdman A, Manoguerra A, et al. Dextromethorphan poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(6):662-677. [PubMed]
13.
Scharman E, Erdman A, Cobaugh D, et al. Methylphenidate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(7):737-752. [PubMed]
14.
Cobaugh D, Erdman A, Booze L, et al. Atypical antipsychotic medication poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(8):918-942. [PubMed]
15.
Caravati E, Erdman A, Christianson G, et al. Elemental mercury exposure: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2008;46(1):1-21. [PubMed]
16.
Manoguerra A, Erdman A, Woolf A, et al. Valproic acid poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2008;46(7):661-676. [PubMed]
Bryan D. Hayes, PharmD, FAACT

Bryan D. Hayes, PharmD, FAACT

Associate Editor, ALiEM
Creator and Lead Editor, CAPSULES series, ALiEMU
Clinical Pharmacist, EM and Toxicology, MGH