Friday, July 22, 2011

Drug overdose in children



My phone kept on ringing. I grabbed it and started reading the message. One of my toddler patient drank half bottle of carbocisteine.They were asking me what to do. I was at the middle of replying to this message when my phone rang again. This time, it was a call from an unknown number.

I was thinking of ignoring this call (but...what the hell...it can be one of those times  when the mother would ask something silly ,and sometimes i couldn’t help but LMAO.) But seriously,she was the grandma of the 2 year old child who drank carbocisteine syrup. She sounded anxiously worried .I told her to watch out for signs of  toxicity then bring her to the ER just in case any of the signs develop. I saw that kid .Nothing remarkable happened.
Meanwhile, My 10 year old kid has this ugly bronchitis he got from somewhere. He’s drinking Azithromycin  500 mg tab once a day for this. When it was time for the usual dose, i asked him to get the medicine from my purse. He found it and drank it. Shortly afterwards,  his dad noticed that the medicine wrapper was different and he asked him what specifically did he swallow. It turned out to be LOSARTAN. It’s an antihypertensive drug designed to be taken once a day!!  
Possible side effects to a 10 year old kid: The opposite of hypertension, HYPOTENSION. I’ve thought of admitting him in the hospital so he can be hooked with IV fluids, monitored intensely and  given timely intervention.
And Just like what i always tell my patient’s parent, I reminded myself that  NO parent or grandparent would want this to happen to kids they love.(But shit, I still feel distraught though.)
But after careful rationalization, we stayed  at home.
The threshold was 80 systolic. And If his BP hits 85 and below...we’re going ICU...non-stop, full blast .I can visualize the first line of my order sheet then the next then the next. My head was whirling with possible scenarios. But i paused. I took his baseline BP. It  was  initially 100 and i continuously monitored him every hour. The Bp dipped to 87 at 5am. Safe. Nice.
 At 530 am, my husband asked me what my treatment plan was. I told him that I'm letting him RUN as soon as he wakes up.(I guess telling him a scary story or threatening him with "make your assignment or else..."  won't make BP elevate significantly.)
What to do when your child accidentally swallowed medicine:
1.       Identify :
                a. What medicine he took.
                b. How much he drank. 
                c. What time he drank them.
2.       Bring him to the doctor. Tell the doctor the answers of number 1.
                When a doctor knows what the child took; specific signs and symptoms are guarded. Or a specific antidote may be given. On the other hand. Not knowing what was given will give your doctor a difficult time figuring it out. There may be even a time when intervention will have to be given only after complication has set in. ANTICIPATION is the key. Give the doctor the answers he needs.Then the doctor should label the patient admissible or non-admissible in the hospital. (There are kids who don't need admission.)
3.       If your kids are old enough to understand, discuss this with them. Make sure that it won’t happen again. Put medicines where they can’t reach them.