Exposição aguda a derivados imidazolínicos em crianças

Bucaretchi, Fábio; Dragosavac, Sanja; Vieira, Reinaldo Wilson

doi:10.1590/s0021-75572003000600010

Cited by 10 publications

(7 citation statements)

References 11 publications

(36 reference statements)

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“…21 In fact, there is no consensus regarding the dosage or duration of treatment with topical nasal decongestants, including those that can be purchased without a prescription (except for those containing vasoconstrictors). 22 These factors may result in an increase in the number of times the IDDD contacts the nasal vestibule and raises the possibility of contamination and/or recontamination, increasing the risk to users.…”

Section: Discussionmentioning

confidence: 99%

Intranasal drug delivery devices are a potential contamination source of airways

Pereira¹,

Soares²,

Innocencio³

et al. 2019

Brazilian Journal of Allergy and Immunology (BJAI)

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Background: The use of intranasal drug delivery devices (IDDD) for the treatment of allergic rhinitis (AR) is frequent because they are simple, efficient, and safe, and mainly because they are perceived as low-risk. However, it is speculated that contact between the nasal mucosa and an IDDD may give rise to infections once the nose is colonized by bacteria, and there are currently no proper instructions for IDDD sanitization. The objective of this study was to evaluate the possibility of contamination of an IDDD for topical medication after simulating use in healthy individuals. Methods: The in vitro study consisted of 14 healthy individuals of both sexes, between the ages of 18 and 24 years. Samples were collected immediately after the opening of each IDDD and after simulating use by the subjects. Afterwards, the samples were deposited in tubes and kept in an incubator at 37 °C. After 48 hours, the samples were inoculated on Müller-Hinton agar. Qualitative analyses of the appearance of the samples were performed after 24 and 48 hours, and after 72 hours the presence or absence of bacteria was evaluated macroscopically. Results: After 24 hours of incubation, 21.4% (n = 3) of the samples presented with a turbid appearance and after 48h, 71% (n = 10) of the samples presented with a turbid appearance and positive bacterial growth. Conclusion: The results suggest that IDDDs for topical medications may be important sources of contamination or recontamination of the nasal mucosa of individuals who are being treated for upper respiratory tract conditions. A better understanding of the risks of re-using IDDDs after previous contact with the nasal mucosa will improve guidelines on hygiene procedures and prevention of related risks.

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Section: Discussionmentioning

confidence: 99%

Intranasal drug delivery devices are a potential contamination source of airways

Pereira¹,

Soares²,

Innocencio³

et al. 2019

Brazilian Journal of Allergy and Immunology (BJAI)

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“…Similar cases evolve favorably within the first 24 hours without the need for invasive procedures, with improvement in episodes of apnea and bradycardia after intermittent tactile stimulation. 23,24 In fatal case 4, clinical manifestations and severe hypoglycemia at admission suggest that an oral hypoglycemic intake may also have occurred. 25 Impaction of button batteries in esophageal lumen can lead to high morbidity, including lethal outcomes.…”

Section: Prolonged Parenteral Nutritionmentioning

confidence: 99%

Severe Acute Toxic Exposures in Children and Adolescents: Case Series

Anjos

Ricardi

Borrasca-Fernandes

et al. 2021

Rev. paul. pediatr.

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Objective: To describe a case series of severe acute toxic exposures (SATE) in individuals <20 years old followed-up by a regional Poison Control Center (PCC). Methods: Descriptive cross-sectional study. All patients who were <20yo and classified as score 3 (severe) and 4 (fatal) following Poisoning Severity Score were included for analysis. According to the outcome, patients were classified as PSS 3 when they developed intense clinical manifestations with risk of death or important sequelae; and as PSS 4 when death had resulted from direct cause or complication of the initial exposure. The data of patients were obtained from the Brazilian electronic database system (DATATOX). Results: During the biennium 2014-2015, Campinas PCC followed up 5,095 patients <20yo, with 30 being classified as SATE (PSS=3, n=24; PSS=4, n=6). The exposures circumstances were unintentional (15); intentional (14; suicide attempt = 11; street drugs consumption = 3); and not explained (1). The exposures were significantly more frequent in adolescents >14yo (n=17; p<0.01). The involved agents were venomous animals (8; scorpions=5); medicines (8; miscellaneous=6); chemicals (6); illegal rodenticides containing acetylcholinesterase inhibitors (chumbinho, 4); drugs of abuse (3); button battery (1). Three patients evolved with sequels (esophageal stricture post-corrosive ingestion). The median length of hospital stay was 6 days (IQR: 5-12 days); 26 patients were treated in intensive care units, and 22 of them needed mechanical ventilation; 12, inotropic/vasopressors; and 3, renal replacement therapy. Conclusions: Scorpion stings and poisonings caused by medicines and chemicals were the main causes of SATE. The SATE were significantly more frequent in adolescents, due to deliberate self-poisoning.

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“…[42][43] AAPCC-TESS data (1993)(1994)(1995)(1996)(1997)(1998)(1999) show a significant increase in clonidine exposure in children, related to an increase in the prescription of this drug for the management of attention deficit hyperactivity d i s o r d e r . 4 2 C l o n i d i n e p o i s o n i n g c a u s e s c l i n i c a l m a n i f e s t a t i o n s t h a t r e s e m b l e t h o s e o f t o p i c a l decongestants containing imidazoline derivatives, 44 with rapid onset of action, 30 to 60 minutes after exposure. 9,42 Common clinical signs in children include central nervous system depression, hypothermia, bradycardia, miosis, and respiratory depression, which develop when a dose of clonidine greater than 10 µg/kg is ingested.…”

Section: Naloxonementioning

confidence: 99%

“…9 Treatment is based on supportive care. 9,42,44 Naloxone has been empirically used and no controlled studies exist that support its use. 9,[42][43] Flumazenil Benzodiazepines are among the most widely prescribed drugs around the world and are the major cause of toxic exposure to medications in our setting.…”

Section: Naloxonementioning

confidence: 99%

Exposições tóxicas agudas em crianças: um panorama

Bucaretchi¹,

Baracat²

2005

J. Pediatr. (Rio J.)

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Summary of the findings: Acute toxic exposure in children is a common event, mainly in children under six years of age. Death is rare. Although widely employed, there is no evidence that gastrointestinal decontamination and multiple-dose activated charcoal improve the outcome of poisoned patients. Very few efficient antidotes are used on a consistent basis, and some of them are very expensive and not available in Brazil.Conclusions: Ipecac syrup and cathartics should not be administered on a routine basis in acute toxic exposures in outpatient treatment. Excluding the contraindications, single-dose activated charcoal and gastric lavage may be considered within one hour of ingestion if a patient ingested a potentially toxic amount or a potentially lethal amount, respectively. Whole bowel irrigation, multiple-dose activated charcoal and urine alkalinization may be considered in a few situations. Fomepizole and octreotide are safe and efficient antidotes, which can be used in the treatment of alcohol (methanol and ethylene glycol) and sulfonylureas poisoning, respectively. J Pediatr (Rio J). 2005;81(5 Suppl):S212-S222: Poisoning, gastrointestinal decontamination, charcoal, antidotes, children.

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Exposição aguda a derivados imidazolínicos em crianças

Cited by 10 publications

References 11 publications

Intranasal drug delivery devices are a potential contamination source of airways

Intranasal drug delivery devices are a potential contamination source of airways

Severe Acute Toxic Exposures in Children and Adolescents: Case Series

Exposições tóxicas agudas em crianças: um panorama

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