Overdoses, fatal children

Of greater concern is the safety of the TCAs. Toxic levels of these medications can produce lethal cardiac arrhythmias, seizures, and suppression of breathing. An overdose of a 1-2 week supply of most TCAs is often fatal, a serious consideration when prescribing medication to depressed patients with suicidal thoughts. Children taking imipramine for treatment of ADHD have died from sudden cardiac death consequently, child psychiatrists seldom use TCAs. Likewise, patients with heart disease or seizure disorders are more likely to have dangerous complications from TCAs and should avoid them. 

Toxicity. The estimated minimum lethal dose is 5 g. Toxic effects during treatment are frequent and may occur even when the dose does not exceed 400 mg daily they are usually associated with plasma concentrations above lOOpg/ml. A considerable number of deaths have occurred, especially from blood disorders. In a fatality due to an accidental overdose by a 5-year-old child, the following postmortem concentrations were reported blood 400 pg/ml, bile 475 pg/ml, kidney 250 pg/g, liver 250 pg/g (K. L. Lam and K. Chien, Bull. int. Ass. forens. Toxicol., 1976, 12 2), 20). 

In a fatal case, a massive overdose of 340 ml Renigrafin 76 was injected into a 7-year-old child with coarctation of the aorta, and computed tomography showed the presence of contrast agent in the brain (98). 

Fatal accidental overdose has been reported in a child (71). 

If the prenatal vitamins have iron, this is a life-threatening situation. The child can hemorrhage because of the ulcerogenic effects of unbound iron, causing shock. As few as 10 tablets of ferrous sulfate (3 g) taken at one time can be fatal within 12 to 48 hours. This is the most important question to ask to determine what treatment the child should have for the accidental overdose. 

A. Clonidine. As little as one tablet of 0.1-mg clonidine has produced toxic effects in children however, 10 mg shared by twin 34-month-old girts was not lethal. Adults have survived acute ingestions with as much as 100 mg. No fatalities from acute overdoses have been reported, but a child had permanent neurological damage following a respiratory arrest. 

Madadi P, Hildebrand D, Gong lY, Schwarz UI, Ciszkowski C, Ross CJD, Sistonen J, Carleton BC, Hayden MR, Lauwers AE, Koren G. Fatal hydroco-done overdose in a child pharmacogenetics and drug interactions. Pediatrics 2010 126 e986-9. 

Overdose A case report of a 13-month-old child who experienced respiratory and subsequent cardiac arrest after ingestion of a single pill of buprenorphine/naloxone (8mg/2 mg) highlights the risk of a single dose of buprenorphine to be fatal to children [87 ]. 

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