Amlodipine Toxicity in Children Less Than 6 Years of Age: A Dose-Response Analysis Using National Poison Data System Data

Benson, Blaine E.; Spyker, Daniel A.; Troutman, William G.; Watson, William A.; Bakhireva, Ludmila N.

doi:10.1016/j.jemermed.2009.02.016

Cited by 23 publications

(25 citation statements)

References 31 publications

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“…Poison centers also provide significant economic benefits, reducing healthcare costs by safely treating less dangerous exposures at home [1][2][3][4][5][6][7][8] and reducing hospital stays. 9,10 In addition, poison center data extend our understanding of dose response, 11,12 improve public health and chemical terrorism surveillance, 13,14 and provide valuable insights into product safety. 15,16 To be effective, poison centers must be utilized by their service populations.…”

Section: Introductionmentioning

confidence: 99%

Determinants of U.S. poison center utilization

Litovitz

Benson

Youniss

et al. 2010

Clinical Toxicology

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Section: Introductionmentioning

confidence: 99%

Determinants of U.S. poison center utilization

Litovitz

Benson

Youniss

et al. 2010

Clinical Toxicology

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“…The exact toxic dose for each has not been fully established. However, it is recommended that patients are monitored for toxicity if >0.3 mg/kg of amlodipine is ingested in children, [23] and if >10 mg is ingested by an adult. Asymptomatic patients should be observed for 24 hours in a monitored setting if a sustained-release preparation has been ingested.…”

Section: General Management Resuscitation and Decontaminationmentioning

confidence: 99%

“…[14,17,22] A 10% dextrose infusion should be commenced to maintain normoglycaemia, and fingerprick glucose testing should be done 30 minutes after HIET is started and hourly thereafter. [11,14,17,23] Higher concentrations of dextrose water, for example 50%, may be required. [25] However, hyperglycaemia despite high doses of HIET can occur [24,25] and may indicate the severity of CCB poisoning.…”

Section: In Practicementioning

confidence: 99%

“…Hypokalaemia and hypoglycaemia are two expected complications of HIET and must be monitored for and treated diligently. [11,14,17,[22][23][24][25] Hypokalaemia and hypoglycaemia are not indications to stop HIET if haemodynamic stability has not yet been achieved. Hypokalaemia is common and seldom life threatening provided that potassium replacement is continued during HIET and serial serum potassium monitoring is done.…”

Section: Complications During Treatmentmentioning

confidence: 99%

“…Effective cardiopulmonary resuscitation and attention to advanced cardiac life support principles remain the mainstay of therapy in CCB-induced cardiac arrest. [14,23] In refractory shock, ensure that the maximum doses of HIET, up to 10 IU/kg/h, have been used; however, even higher doses have been used safely. [18,22,24] Intravenous lipid emulsion therapy (ILE) may be tried in the peri-arrest or arrested patient, although evidence of efficacy is scarce.…”

Section: The Patient In Refractory Shock and The Patient In Cardiac Amentioning

confidence: 99%

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Emergency management of calcium channel blocker overdose

Stephen

Pluymers²,

Gauton³

2019

S Afr Med J

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Calcium channel blockers (CCBs) are commonly used in South Africa (SA) in the management of hypertension and other cardiovascular disease. Their ubiquitous availability makes them a common agent in drug overdose (OD), whether through accidental ingestion or deliberate self-harm. It is essential that medical practitioners know how to recognise and manage CCB OD, as severe CCB OD is often fatal. As there is a lack of local literature in SA, we highlight the general principles of management of CCB OD, as well as complications and problems that may be encountered during treatment. This narrative review is based on existing clinical guidelines, retrospective studies and systematic reviews on the emergency management of CCB OD. High-dose insulin euglycaemic therapy has become the mainstay of treatment in severe CCB OD. The rationale, the recommended protocol for its use and its adverse effects are described.S Afr Med J 2019;109(9):635-638. https://doi.

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Antihypertensive agents: a long way to safe drug prescribing in children

Siddiqi

Shatat

2019

Pediatr Nephrol

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Recently updated clinical guidelines have highlighted the gaps in our understanding and management of pediatric hypertension. With increased recognition and diagnosis of pediatric hypertension, the use of antihypertensive agents is also likely to increase. Drug selection to treat hypertension in the pediatric patient population remains challenging. This is primarily due to a lack of large, well-designed pediatric safety and efficacy trials, limited understanding of pharmacokinetics in children, and unknown risk of prolonged exposure to antihypertensive therapies. With newer legislation providing financial incentives for conducting clinical trials in children, along with publication of pediatric-focused guidelines, literature available for antihypertensive agents in pediatrics has increased over the last 20 years. The objective of this article is to review the literature for safety and efficacy of commonly prescribed antihypertensive agents in pediatrics. Thus far, the most data to support use in children was found for angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), and calcium channel blockers (CCB). Several gaps were noted in the literature, particularly for beta blockers, vasodilators, and the long-term safety profile of antihypertensive agents in children. Further clinical trials are needed to guide safe and effective prescribing in the pediatric population.

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Amlodipine Toxicity in Children Less Than 6 Years of Age: A Dose-Response Analysis Using National Poison Data System Data

Cited by 23 publications

References 31 publications

Determinants of U.S. poison center utilization

Determinants of U.S. poison center utilization

Emergency management of calcium channel blocker overdose

Antihypertensive agents: a long way to safe drug prescribing in children

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