Pediatric emergency medicine trisk 3159 3159

Optimal treatment of significant sedative overdose includes continuous monitoring in an intensive care unit, often with intubation and ventilator support as indicated Flumazenil, a benzodiazepine antagonist, can be administered in select cases of suspected benzodiazepine ingestion Its pediatric dose is 0.01 to 0.02 mg/kg IV (max 0.2 mg/dose) and may be repeated to a maximum of 0.05 mg/kg or mg, whichever is less Indications for flumazenil administration may be (i) to reverse a witnessed, unintentional benzodiazepine overdose in a young child or (ii) to prevent airway intubation after an iatrogenic overdose Flumazenil must not be given empirically in unknown or intentional overdoses as it may induce potentially life-threatening seizures Opioids CLINICAL PEARLS Naloxone, an opioid antagonist, is the first line of therapy for patients with opioid-induced respiratory depression Doses as low as 0.2 to 0.4 in opioid-dependent patients may precipitate withdrawal and should be given cautiously In opioid-naive children, the initial naloxone dose is 0.1 mg/kg Buprenorphine is a partial opioid agonist which is becoming the mainstay of medication-assisted therapy for opioid use disorder Pediatric toxicity from buprenorphine is similar to toxicity from full opioid agonists Current Evidence In the past two decades, recreational abuse of insufflated heroin and ingested prescription opioid analgesics (particularly oxycodone and hydrocodone) has risen to epidemic proportions in the United States and may be partly responsible for the first increase in overall drug-related mortality in a generation In addition, some opioid-related deaths are likely inadvertent and represent inappropriate misuse of combinations of alcohol, sedative-hypnotic agents, and prescription analgesics The significant rate of opioid abuse has also given rise to the common treatment of opioid addiction by the outpatient prescription of buprenorphine (a partial opioid agonist) which has resulted in the opioid syndrome in toddlers when they ingest this agent While the partial agonist behavior of buprenorphine