{
"topic": "Drug Overdose",
"slug": "drug-overdose",
"category_id": 15265,
"passage_count": 14,
"source_chars": 11717,
"enough_material": true,
"references": [
{
"title": "Berkowitz's Pediatrics",
"author": "Berkowitz, Carol D.;",
"pages": [
104,
105
]
},
{
"title": "Pediatric Decision-Making Strategies",
"author": "Pomeranz, Albert J.",
"pages": [
225
]
},
{
"title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
"author": null,
"pages": []
},
{
"title": "Pediatric Dentistry: Infancy through Adolescence - Arthur J. Nowak, John R. Christensen, Tad R. Mabry, Janice A. Townsend, Martha H. Wells - 6th Edition (2018) 656 pp., ISBN: 978-0-323-60826-8",
"author": "Arthur J. Nowak, John R. Christensen, Tad R. Mabry, Janice A. Townsend, Martha H. Wells",
"pages": [
123
]
},
{
"title": "Pediatric Clinical Practice Guidelines and Policies",
"author": "American Academy of Pediatrics (AAP);",
"pages": [
1341
]
},
{
"title": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition",
"author": "American Academy of Pediatrics",
"pages": [
1292,
1311,
1325
]
},
{
"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
"author": null,
"pages": [
728,
1221
]
},
{
"title": "Netters Pediatrics (Florin \u0422., Ludwig St.)",
"author": null,
"pages": [
80
]
}
],
"passages": [
{
"source": "Berkowitz's Pediatrics, p. 104",
"text": "Furthermore, according to the Centers for Disease Control and Prevention, each year more than 60,000 children are brought to the emergency department (ED) for medication overdoses; OTC medications were implicated in more than 26,000 visits. Ninety percent of ED visits for medication overdoses resulted from unsupervised ingestions of prescription and OTC drugs, with peak incidence in the younger-than-5-year age group. Most drugs prescribed for children have not been tested in children. Before the US Food and Drug Administration (FDA) initiated a pediatric program (Best Pharmaceuticals for Children **79**"
},
{
"source": "Berkowitz's Pediatrics, p. 105",
"text": "## **Patient Characteristics** Infants and children have different physiological characteristics than adults, including immaturity of metabolic and organ function. Body weight and surface area are considerations in drug dosing for pediatrics. In addition, the therapeutic window for many drugs is smaller for children than adults. Pharmacological factors, including age-based variability in absorption, metabolism, and excretion of drugs in children compared with adults, as well as age-specific contraindications of certain medications, pose special vulnerabilities for children to the adverse effects of overdosing. Conversions of doses from ingredient amounts to volumes for liquids labeled for home use are also problematic."
},
{
"source": "Pediatric Decision-Making Strategies, p. 225",
"text": "Dehydration overdose
Encephalitis 3 Cerebral edema (due to Diabetic ketoacidosis
Acute disseminated head trauma) Other metabolic disorders 109
encephalomyelitis Tumor Arrhythmia
(ADEM) Arteriovenous malformation Migraine with aura (acute
Infectious Aneurysm confusional, familial hemiplegic)
Autoimmune Hydrocephalus (including Intussusception 101
Other infections 4 VP shunt malfunction) Carbon monoxide 112
Brain abscess Hypertensive, hypoxic-ischemic
Vascular insult (stroke, and other encephalopathies 112
embolism, vasculitis)vasculitis) Reye syndrome 123
**----- End of picture text -----**
"
},
{
"source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
"text": "by being in an environment where drugs of abuse are used (e.g., marijuana, cocaine, phencyclidine [PCP], methamphetamine) or manufactured. In any of these circumstances, the exposure can be sufficient to produce severe intoxication. Thus, knowledge of the epidemiology and manifestations of substance use becomes important in the management of children of all ages."
},
{
"source": "Pediatric Dentistry: Infancy through Adolescence - Arthur J. Nowak, John R. Christensen, Tad R. Mabry, Janice A. Townsend, Martha H. Wells - 6th Edition (2018) 656 pp., ISBN: 978-0-323-60826-8, p. 123",
"text": "## **Body Habitus and Integument** Children are obviously smaller than adults. It makes intuitive sense that they need smaller drug doses to maintain therapeutic drug concentrations and that smaller doses are needed to produce toxicity. The \u201cmaximal safe dose\u201d listed in standard drug reference manuals is potentially enough to overdose an undersized pediatric patient. Because of this, practitioners have recognized several formulas, including Young\u2019s and Fried\u2019s rules, to adjust an established adult dose to a safe dose for a pediatric patient based on the child\u2019s age: ## **Young\u2019s rule:** Pediatric dosage   Since a wide degree of size variability exists among similarly aged children, a weight-based dosing formula, such as Clark\u2019s rule, became very popular[19] : "
},
{
"source": "Pediatric Clinical Practice Guidelines and Policies, p. 1341",
"text": "ABSTRACT. Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Round-the-clock dosing of opioids can produce opioid dependence within 5 days. According to a 2001 consensus paper from the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, dependence is defined as \u201ca state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.\u201d Although the experience of many children undergoing iatrogenically induced withdrawal may be mild or goes unreported, there is currently no guidance for recognition or management of withdrawal for this population. Guidance on this subject is available only for adults and primarily for adults with substance use disorders. The guideline will summarize existing literature and provide readers with information"
},
{
"source": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition, p. 1311",
"text": "ABSTRACT. Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Round-the-clock dosing of opioids can produce opioid dependence within 5 days. According to a 2001 consensus paper from the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, dependence is defined as \u201ca state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.\u201d Although the experience of many children undergoing iatrogenically induced withdrawal may be mild or goes unreported, there is currently no guidance for recognition or management of withdrawal for this population. Guidance on this subject is available only for adults and primarily for adults with substance use disorders. The guideline will summarize existing literature and provide readers with information"
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 1221",
"text": "## **OVERDOSE SYNDROME** Overdose syndrome is an acute reaction after administration of an opiate. It is the leading cause of death among substance users. Many opiate overdoses are complicated by polydrug use (Fig. 157.4). The clinical signs include stupor or coma, seizures, miotic pupils (unless severe anoxia has occurred), respiratory depression, cyanosis, and pulmonary edema. The differential diagnosis includes CNS trauma, diabetic coma, hepatic (and other) encephalopathy, Reye syndrome, and overdose of alcohol, barbiturates, PCP, or methadone. Diagnosis of opiate toxicity is facilitated by IV administration of naloxone 0.1 mg/kg, not to exceed 2 mg, which causes dilation of pupils constricted by the opiate. Diagnosis is confirmed by the finding of opiates in the urine and/or serum. ## **TREATMENT**"
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 728",
"text": "Media and government attention to the \u201copioid epidemic\u201d has reasonably led to scrutiny of the prescription of opioids to children, and FDA approval of opioid formulations for children has raised alarm and criticism by some vocal critics of the use of opioids for medical purposes. Thus one of the potent barriers to effective management of pain with opioids is the fear of addiction held by many prescribing pediatricians and parents alike. Pediatricians should understand the phenomena of tolerance, dependence, withdrawal, and addiction (Table 93.11). **Opioid addiction** is the result of the complex interplay of genetic predisposition, psychiatric pathology, and social forces, including poverty, joblessness, hopelessness, and despair. The dramatic increase in the amount of opioid abuse and overdoses and opioid- related deaths, although highest in the adult non-Hispanic American Indian or Alaska Native population age 35\u201344 years old, has also significantly risen in children and adolescents. Among persons 14\u201318"
},
{
"source": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition, p. 1325",
"text": "ABSTRACT. Drug testing is often used as part of an assessment for substance use in children and adolescents. However, the indications for drug testing and guidance on how to use this procedure effectively are not clear. The complexity and invasiveness of the procedure and limitations to the information derived from drug testing all affect its utility. The objective of this clinical report is to provide guidance to pediatricians and other clinicians on the efficacy and efficient use of drug testing on the basis of a review of the nascent scientific literature, policy guidelines, and published clinical recommendations. (5/14) ## **http://pediatrics.aappublications.org/content/133/6/e1798** ## **TOBACCO USE: A PEDIATRIC DISEASE** ## _Committee on Environmental Health, Committee on Substance_ ## _Abuse, Committee on Adolescence, and Committee on Native American Child Health_"
},
{
"source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 80",
"text": "AV, atrioventricular; CNS, central nervous systeml; GI, gastrointestinal. _Compiled from Eldridge DL, Van Eyk J, Kornegay C: Pediatric toxicology. Emerg Med Clin North AM 15:283-308, 2007 and Osterhoudt K, Shannon M, Burns Ewald M, Henretig F: Toxicologic emergencies. In Fleisher GR, Ludwig S (eds):_ Textbook of Pediatric Emergency Medicine _, ed 6. Philadelphia, Lippincott Williams_ & _Wilkins, 2010, pp 1171-1223._ 5 mg/kg. Methadone, however, is a longer acting medication and can be toxic in doses as low as 5 mg. Therefore, the AAPCC recommends close observation for opioid-na\u00efve children ingesting more than 5 mg of methadone or any dose of extendedrelease opioids. metabolic changes that are not typically seen in a more common illness. Nevertheless, there are characteristic clinical features, representing in particular altered central and autonomic nervous system findings, which have been termed \u201ctoxidromes\u201d (Table 9-2). ## _Antidiarrheals_"
},
{
"source": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll), p. 120",
"text": "NAPQI, _N_ -acetyl- _p_ -benzoquinone imine. **Table 7.3** Physical findings that may help identify different classes of drugs in overdose  **----- Start of picture text -----**
Heart rate
and blood Respiratory
Type of effect pressure rate Temperature Pupils Sweating
Anticholinergic Increased No effect Increased Dilated Reduced
(e.g. tricyclic
antidepressants,
antihistamines)
Opioid (e.g. morphine, Reduced Reduced Reduced Constricted Reduced
codeine)
Sympathomimetic Increased Increased Increased Dilated Increased
(e.g. cocaine,
amphetamines)
Sedative-hypnotic Reduced Reduced Reduced No effect Reduced
(e.g. anticonvulsants,
benzodiazepines)
**----- End of picture text -----**
107 **7**  ## ~~**Case history 7.2**~~ ## **A 14-year-old girl with vomiting and abdominal pain**"
},
{
"source": "Pediatric Board Study Guide, p. 102",
"text": "- Suicide attempt - Altered mental status ## **Consent for Drug Testing** - Drug testing of older competent adolescent should be voluntary ## **Over-the-Counter and Prescription Medicines** ## **Eating Disorders** - Commonly abused over-the-counter medications: Cold medicines (pseudoephedrine), cough medicines (dextromethorphan), analgesics (acetaminophen) - Commonly abused prescription medications: Stimulants, opioids, sedatives, anxiolytics - Risk factors for abuse of over-the-counter and prescription medicines - Family history of substance abuse problems, history of or current substance use, peer pressure, easy access to prescription drugs (personal prescription or family member has a prescription), lack of knowledge regarding potential harm ## **Introduction** - Eating disorders are serious mental health conditions in children, adolescents, and young adults."
},
{
"source": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition, p. 1292",
"text": "ABSTRACT. Overuse is one of the most common etiologic factors that lead to injuries in the pediatric and adolescent athlete. As more children are becoming involved in organized and recreational athletics, the incidence of overuse injuries is increasing. Many children are participating in sports year-round and sometimes on multiple teams simultaneously. This overtraining can lead to burnout, which may have a detrimental effect on the child participating in sports as a lifelong healthy activity. One contributing factor to overtraining may be parental pressure to compete and succeed. The purpose of this clinical report is to assist pediatricians in identifying and counseling at-risk children and their families. This report supports the American Academy of Pediatrics policy statement on intensive training and sport specialization. (6/07, reaffirmed 3/11, 6/14) ## **http://pediatrics.aappublications.org/content/119/6/1242** ## **OXYGEN TARGETING IN EXTREMELY LOW BIRTH WEIGHT INFANTS (CLINICAL REPORT)**"
}
]
}