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      Is Open Access

      Antidotes for childhood toxidromes

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          Abstract

          Background

          Poisoning causes significant morbidity and sometimes mortality in children worldwide. The clinical skill of toxidrome recognition followed by the timely administration of an antidote specific for the poison is essential for the management of children with suspected poisoning. This is a narrative review on antidotes for toxidromes in paediatric practice.

          Methods

          A literature search was conducted on PubMed with the keywords “antidote”, “poisoning”, “intoxication”, “children” and “pediatric”. The search was customized by applying the appropriate filters (species: humans; age: birth to 18 years) to obtain the most relevant articles for this review article.

          Results

          Toxidrome recognition may offer a rapid guide to possible toxicology diagnosis such that the specific antidote can be administered in a timely manner. This article summarizes toxidromes and their respective antidotes in paediatric poisoning, with an emphasis on the symptomatology and source of exposure. The antidote and specific management for each toxidrome are discussed. Antidotes are only available for a limited number of poisons responsible for intoxication. Antidotes for common poisonings include N-acetyl cysteine for paracetamol and sodium thiosulphate for poisoning by cyanide.

          Conclusion

          Poisoning is a common cause of paediatric injury. Physicians should be familiar with the recognition of common toxidromes and promptly use specific antidotes for the management of childhood toxidromes.

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          Most cited references73

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          Management of opioid analgesic overdose.

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            Methemoglobinemia: pathogenesis, diagnosis, and management.

            The diagnosis of methemoglobinemia should be considered in patients presenting with cyanosis and hypoxia. A variety of frequently used medications are capable of inducing methemoglobinemia, with dapsone and benzocaine being common culprits. Unique features, such as a saturation gap and chocolate-brown-colored blood, can raise suspicion for methemoglobinemia. Typically, symptoms correlate with the methemoglobin level, and treatment with methylene blue is reserved for patients with significantly elevated methemoglobin levels. In the presence of comorbid conditions that impair oxygen transport, however, low-grade methemoglobinemia can become symptomatic and may warrant treatment.
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              Tricyclic antidepressant overdose: a review.

              Overdoses of tricyclic antidepressants are among the commonest causes of drug poisoning seen in accident and emergency departments. This review discusses the pharmacokinetics, clinical presentation and treatment of tricyclic overdose.
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                Author and article information

                Journal
                Drugs Context
                Drugs Context
                DIC
                Drugs in Context
                BioExcel Publishing Ltd
                1745-1981
                1740-4398
                2021
                02 June 2021
                : 10
                : 2020-11-4
                Affiliations
                [1 ]Department of a Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Hong Kong
                [2 ]Department of Pediatrics, The University of Calgary and The Alberta Children’s Hospital, Calgary, Alberta, Canada
                Author notes
                Correspondence: Kam Lun Hon, 9/F, Tower B, Hong Kong Children’s Hospital, 1 Shing Cheong Road, Kowloon Bay, Kowloon, Hong Kong SAR. Email: ehon@ 123456hotmail.com
                Author information
                https://orcid.org/0000-0002-6682-5529
                https://orcid.org/0000-0001-5941-1478
                https://orcid.org/0000-0003-2254-6971
                Article
                dic-2020-11-4
                10.7573/dic.2020-11-4
                8177957
                49a07c24-d5a7-41d1-b1d0-1c4cb10eb9c9
                Copyright © 2021 Hon KL, Hui WF, Leung AKC

                Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

                History
                : 19 November 2020
                : 20 April 2021
                Categories
                Review

                antidote,extracorporeal treatment,intoxication,paediatric poisoning,toxidrome

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