Atropine pediatric

Diphenoxylate w/Atropine Pediatric Dosage Age (years) Approximate weight Dosage (mL) (4 times daily)... 

The release of a nerve agent near a school would put a strain on local prehospital and in-hospital resources, with airway equipment, supplies of 2-PAM and atropine, and pediatric intensive care beds being quickly used and depleted (Aghababian, 2002). Therefore, health care professionals should know how their community accesses the Strategic National Stockpile (SNS) and other resources to obtain medications and supplies in a timely manner. Additionally, hospitals should keep a 48-hour supply of pediatric equipment and pharmaceuticals on hand for their average daily census of pediatric patients, plus an additional 100 patients (Markenson Redlener, 2004). Stockpiled pharmaceuticals and equipment should be specifically for pediatric use or appropriately substituted for such use (Markenson Redlener, 2004). Hospital operations and preparedness policies should include pediatric care and treatment guidelines (Markenson Redlener, 2004). 

Although atropine use is standard, clinicians are sometimes faced with the dilemma of administering atropine to a pediatric patient with an elevated heart rate. Due to the fact that children may manifest tachycardia with toxic exposures... 

PEAP (Pediatric Expert Advisory Panel) (2004). Atropine use in children after nerve gas exposure. Columbia University Mailman School of Public Health 1 1-8. 

A study investigating the use of atropine for treatment of amblyopia indicated it was as successful as patching therapy. Subjects were less than 7 years old and tolerated 1% atropine daily for 2 years without adverse effects. See Pediatric Eye Disease Investigator Group.A randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Arch Ophthalmol 2002 120 268-278. 

Contraindications for homatropine are essentially the same as for atropine. As with atropine, very small amounts of homatropine have been detected in breast milk. According to the American Academy of Pediatrics, however, homatropine use is compatible with breast-feeding, but caution should be exercised when administering homatropine to nursing women. As with topical administration of atropine, homatropine can also induce CNS toxicity in the elderly. 

Pediatric Eye Disease Investigator Gronp. A comparison of atropine and patching treatments for moderate amblyopia by patient age, canse of amblyopia, depth of amblyopia, and other factors. Ophthalmology 2003 110 1632-1637 discnssion 1637-1638. 

Pediatric Eye Disease Investigator Gronp. A randomized trial of atropine vs patching for treatment of moderate amblyopia in children.Arch Ophthalmol 2002 120 268-278. 

If an i.v. line cannot be placed, the intraosseous drug administration route can be used for pediatric patients during, for example, cardiopulmonary resuscitation (CPR) because drug delivery by this route is similar to that for i.v. administration.If drug or fluid deliver by this route is sluggish, a saline flush can be used to clear the needle. Intraosseous administration is used to deliver medications such as epinephrine, atropine, sodium bicarbonate, dopamine, diazepam, isoproterenol, phenytoin, phenobarbital, dexametha-sone, and various antibiotics. ... 

McCarron MM, Challoner KR, Thompson GA. Diphenoxylate-atropine (Lomotil) overdose in children an update (report of eight cases and review of the literature) Pediatrics 1991 87(5) 694-700. 

In mass casualty situations, intravenous antidotes may not be available. In that case, the intramuscular administration is acceptable. Most Emergency Medical Systems in the United States now stock military Autoinjector units containing atropine and pralidoxime, although kits with pediatric doses may not be available. However, in critical situations, children older than 2 or 3 years of age weighing at least 13 kg might benefit from 2 mg of atropine and 600 mg pralidoxime administered intramuscularly with auto-injectors (7). Experience with the accidental atropine auto-injection in 240 Israeli children unexposed to nerve agents revealed that... 

Guidelines for the treatment of pediatric casualties in a potential homeland defense type of situation have been recently published (Rotenberg andNewmark, 2003). They recommend atropine doses scaled to the weight of the child, with 0.05 mg kg-1 per dose being the rough unit dose 2 mg for 40 kg+ 1 mg for 20 kg+ 0.5 for 10 kg+. They recommend that these doses be given every 5-10 min to a moderate or severe pediatric casualty until atropinization is accomplished. 

In a recent evaluation of pediatric poisoning from trimedoxime and atropine-containing autoinjectors in Israel, no serious side effects were associated with exposure to the oxime. Twenty two children who inadvertently injected more than the recommended, age-adjusted dose (1 mg atropine and 40 mg trimedoxime for children 3-8 years or double that dose for persons > 8 years) did not develop severe adverse reactions, nor did they require medical intervention (Kozer et al, 2005). HI 6 dichloride was tested in a double-blind, placebo controlled, ascending dose-tolerance study (HI 6 + 2 mg atropine sulfate) in 24 healthy male volunteers (Clement and Erhardt, 1994). Doses from 62.5 up to 500 mg were well tolerated by the subjects without serious complaints. There were no clinically significant changes in heart rate or ECG, respiration or blood pressure or visual and mental acuity... 

Kozer E, Mordel A, Haim SB et al. (2005). Pediatric poisoning from trimedoxime (TMB4) and atropine automatic injectors. J Pediatr, 146, 41-44. 

Individuals exposed to vapor and exhibiting miosis only or miosis and rhinorrhea only do not usually require antidote treatment and will resolve without medical intervention (Cannard, 2006 ATSDR, 2007), but they should be observed. If rhinorrhea is problematic in these vapor-only cases, then ATSDR (2007) advises intramuscular atropine (0.05mg/kg pediatric 2.0 mg adult) to relieve signs, followed by patient discharge. If eye pain/headache or nausea is problematic in vapor-only... 

Atropine or common antiemetics can be given to provide relief from nausea and vomiting, early signs of HD intoxication (Yu et al., 2003). Excellent choices for pediatric-specific antiemetics include medications such as promethazine, metoclopramide, and ondansetron (Sidell et al., 1997). Persistent vomiting and diarrhea are later signs of systemic toxicity requiring prompt fluid replacement. 

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