or poison control center consultant familiar with its use Bolus dosing of unit/kg IV of regular insulin is then followed by an infusion at 0.5 units to unit/kg with titration performed based on hemodynamics Carefully monitor blood glucose levels Lipid emulsion infusion has shown promise in animal studies and case reports of verapamil toxicity; it is typically given if toxicity is refractory to conventional therapies, including insulin, or if the patient has a cardiac arrest Severe cases may also benefit from pacemaker insertion and consideration of aortic balloon pump and/or ECMO It is unlikely that hemodialysis or hemoperfusion would benefit in most cases Current indications for admission or discharge: Any symptomatic patient should be admitted to the hospital, with level of care determined primarily by the severity of symptoms and hemodynamic parameters Patients who present after exploratory, small-volume ingestions (especially of water-soluble β-blockers) and remain asymptomatic may be candidates for discharge from the ED, but we would recommend discussing all of these cases with your local poison control center or toxicologist to guide management decisions Clonidine Current Evidence Clonidine is a centrally acting α2 -adrenergic agonist used for management of hypertension, but has also gained popularity for management of ADHD, agitation, and opioid withdrawal Given these expanded indications, clonidine has been an increasing agent in both exploratory and intentional ingestions in pediatric patients In addition to enteral formulations, clonidine is available in a transdermal patch formulation Clonidine exerts its antihypertensive effect through stimulation of CNS α2 adrenergic receptors Their stimulation results in decreased secretion of catecholamines into the synaptic cleft, resulting in decreased pulse and blood pressure In addition, clonidine can lead to release of β-endorphins, which may explain the depressed mental status and miosis associated with toxicity An imidazoline compound, clonidine is related to other medications, including tetrahydrozoline and oxymetazoline (common vasoconstrictors found in nasal decongestants and ophthalmic agents), brimonidine (ophthalmic agent), and guanfacine (ADHD) Clinical Considerations Clonidine is an extremely potent drug with typical doses of 100 to 200 μg in adults Therefore, ingestions of small amounts, even a single adult tablet, can potentially lead to significant toxicity in children Initial toxic