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restore serum pH to normal In treating seizures, effective anticonvulsants include the benzodiazepines or phenobarbital (both of which are GABA agonists) Either diazepam (0.1 to 0.3 mg/kg), lorazepam (0.1 mg/kg), or midazolam (0.1 mg/kg) should be administered IV to terminate seizures Midazolam can be administered effectively via the IM route at a dose of 0.2 mg/kg (max 10 mg) Administration of pyridoxine provides specific antidotal therapy for INH poisoning After administration of vitamin B6 , seizures and metabolic acidosis promptly resolve Pyridoxine is given as an IV dose that equals the estimated dose of INH in milligrams In cases in which the ingested amount is unknown, a single dose of g (70 mg/kg in children) of pyridoxine is administered Rarely, repeat administration is necessary Although INH clearance can be enhanced by hemodialysis or hemoperfusion, these techniques are rarely necessary if pyridoxine, activated charcoal, and aggressive supportive care are provided Oral Hypoglycemics Current Evidence Although almost all pediatric patients with diabetes mellitus require insulin therapy for control, the frequent prescription of oral hypoglycemic agents for patients with non–insulin-dependent, adult-onset diabetes has made the availability and, consequently, the ingestion of these medications commonplace among toddlers The scenario typically involves visits to a grandparent’s home (or conversely, a visit by the grandparent to the child’s home) Clinical Considerations The sulfonylureas (chlorpropamide, glipizide, glyburide, glimepiride) are capable of inducing significant hypoglycemia in a toddler after the ingestion of a single tablet In addition, the onset of hypoglycemia may be delayed up to 16 to 24 hours after ingestion Thus, prudent management of such exposures generally implies prolonged close observation and a challenge period of fasting Although chlorpropamide is rarely used today, it may be enhanced by urinary alkalinization The biguanides (e.g., metformin) are unlikely to create hypoglycemia but may promote metabolic acidosis Maintenance of euglycemia is usually accomplished in symptomatic patients with the infusion of glucose in 10% to 20% solutions, supplemented as necessary by bolus doses, for acute management Glucose cannot be used as the sole therapy, however, because the dextrose causes hyperglycemia that then leads to insulin release with resultant hypoglycemia, and a vicious cycle of unstable blood sugars ensues Octreotide, a somatostatin analog that antagonizes insulin release,
Ngày đăng: 22/10/2022, 13:01
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