Unintentional Opioid Ingestions Presenting to a Pediatric Emergency Department

Abstract

Objectives:The purpose of this study was to describe unintentional opioid exposures in young children, including demographics, medical interventions, and clinical outcomes.Methods: This was a retrospective, cross-sectional study of children 0 to 6 years of age with possible opioid exposure over a 3-year period (July 2010 to June 2013). Data collected included sex, age, specific drug, whether they were referred to the emergency department (ED) by the Regional Poison Control Center, presence of symptoms, therapeutic interventions, ED disposition, and clinical outcomes for admitted patients.Results: Median age of patients included in the study was 2 years, and 64% of these children were male. The most common drug of exposure was buprenorphine/naloxone. Of the 429 charts screened, 140 patients were reported to be symptomatic and referred to the ED, of which 113 patients actually presented to the ED. An additional 122 patients presented to the ED without Regional Poison Control Center referral. Of the total 235 patients presenting to ED, 76 (32%) received a therapeutic intervention. Of 231 total opioid exposures, 31 exposures were administered naloxone. Three children underwent endotracheal intubation. Sixty-five patients were hospitalized, with a median length of stay of 1 day. Although there were no fatalities, 1 child suffered severe morbidity (anoxic brain injury).Conclusions: While opioid exposures in young children are a common and potentially life-threatening problem, most children remain asymptomatic. The majority of patients are able to be discharged from the ED after observation, and of those who are admitted, most have favorable outcomes and brief hospital stays. A small number of these patients require considerable medical interventions.

Acute opioid overdose in pediatric patients

“…45,46 Notably, secondhand exposure is an emerging concern, where children come into contact with opioids through drug paraphernalia or environmental contamination in households with frequent opioid use. [47][48][49] Among adolescents, recreational misuse of opioids presents a different profile. Teenagers are more likely to experiment with prescription opioids, and alarmingly, there has been a rise in the use of synthetic opioids like fentanyl, often clandestinely mixed into other recreational drugs.…”

“…In addition, accidental ingestions can result from dosing errors with prescribed medication 45,46 . Notably, secondhand exposure is an emerging concern, where children come into contact with opioids through drug paraphernalia or environmental contamination in households with frequent opioid use 47–49 …”

Sex Differences in Pediatric Poisonings by Age Group: a Toxicology Investigators’ Consortium (ToxIC) Analysis (2010–2016)

“…The pediatric population is especially vulnerable to adverse drug reactions due to their unique physiological profile, such as their lower muscle mass and subsequently less gluconeogenic precursors, leading to increased risk of hypoglycemia [2,4]. Even in low acuity cases, pediatric pharmaceutical ingestions lead to hospital admissions and cause significant healthcare cost burden [5,6]. The rise in unintentional pediatric poisonings has been linked to increased adult prescription use, especially of opioid, medication for addiction treatment, attention deficit hyperactivity disorder (ADHD), cardiovascular, and sedative hypnotic agents [1,[6][7][8][9].…”

“…Even in low acuity cases, pediatric pharmaceutical ingestions lead to hospital admissions and cause significant healthcare cost burden [5,6]. The rise in unintentional pediatric poisonings has been linked to increased adult prescription use, especially of opioid, medication for addiction treatment, attention deficit hyperactivity disorder (ADHD), cardiovascular, and sedative hypnotic agents [1,[6][7][8][9].…”