On the Monitor
Bradycardia + hypotension + bradypnea
Opioids
Clonidine (plus miosis)
Mydriasis, dry skin, urinary retention, delirium, seizures
Diphenhydramine (benadryl)
Among opioids, this drug has a half-life of up to 36 hours, making it particularly dangerous for delayed respiratory depression in children.
Methadone
Teething gel
Benzocaine
Methemoglobinemia
Cyanosis that does not improve with oxygen
Opioids
Naloxone
Mu-opioid receptor antagonist - binds strongly to the same receptors and displaces the bound opioids
Mild tachycardia and 100% sat
Carbon monoxide
Abdominal pain, coffee-ground emesis, shock, and radiopaque pills on KUB
Iron
Why does acetaminophen poisoning sometimes look deceptively benign in the first 12 hours?
Despite a short therapeutic half-life, hepatic metabolism saturation delays clinical toxicity until 12–24 hrs later.
Normal pathways (glucuronidation/sulfation) become saturated.
More gets shunted through CYP2E1 → NAPQI.
Glutathione stores depleted.
NAPQI builds up → hepatocellular necrosis.
Optic neuritis and blindness
Windshield wiper fluid (methanol)
Beta blockers
IV Glucagon
Glucagon activates its own receptors on the heart (not beta receptors) → triggers adenylate cyclase → increases cAMP → cAMP enhances calcium entry into the cells
Bradycardia +/- arrhythmias
Beta blockers (hypoglycemia)
Calcium channel blockers
...
Seizures, wide QRS, and refractory hypotension
Tricyclic antidepressants
Why do we admit ingestions with beta blockers and CCBs to PICU?
Develop hemodynamic changes and cardiovascular collapse 6-12 hours sometimes longer after ingestion
Antifreeze
Hypoglycemia and lactic acidosis after ingestion of this product.
Tylenol
N-acetylcysteine
1) Cysteine= building block for glutathione -> neutralizes harmful free radicals and detoxify harmful substances in the liver
2) Binds to and neutralizes NAPQI
Tachycardia + hypertension + hyperthermia
Sympathomimetics
Anticholinergics
SSRIs
Hyperkalemia, nausea/vomiting, and xanthopsia (yellow/green vision changes)
Digoxin
Which household supplement causes a “latent phase” (child looks better) before shock and hepatic necrosis at 12–24 hrs?
Iron
Nail polish remover
Acetone
Can cause ketosis without acidosis, GI upset, and CNS depression.
Aspirin
IV Sodium bicarbonate
Alkaline urine→ trap salicylate to increase renal excretion
Tachycardia + tachypnea + fever
Salicylates at early stage due to metabolic alkalosis and compensation by respiratory center
Seizures with persistent hypoglycemia
Sulfonylureas
A toddler swallows a button battery and it becomes lodged in the esophagus. By what time can mucosal injury and perforation already be present?
Within 1-2 hours
Toothpaste
Hypoglycemia and liver failure after fluoride toxicity
Sulfonylureas
Octreotide
Synthetic somatostatin analog (hormone that inhibits insulin secretion)→ binds to somatostatin receptors on pancreatic beta cells → prevents insulin secretion→ stops persistent hypoglycemia