manifestations include altered mental status that may range from lethargy to coma Patients may also develop hypothermia In severe intoxications, coma, miosis, and respiratory depression may appear The cardiovascular changes that accompany clonidine intoxications may range from an initial transient period of hypertension (often resolved prior to arrival in the ED) to profound hypotension and bradycardia Clonidine-induced hypertension is believed to result from αadrenergic effects at peripheral vascular receptors prior to the central, antihypertensive effect The clinical picture of clonidine intoxication typically lasts to 24 hours Because patients with severe intoxication often have coma and respiratory depression, emergency endotracheal intubation may be necessary Also, because of blood pressure instability, vascular access should be achieved immediately Hypotension should be treated with fluids and vasopressors as needed Hypertension is generally uncommon, is very transient, and rarely requires specific treatment Activated charcoal binds clonidine In addition to supportive care measures, other pharmacologic interventions may be effective Naloxone has been suggested as a specific antidotal agent after clonidine intoxication, based on case reports of improved mental status and cardiorespiratory function after its administration However, in reported case series, there have not been consistent improvements after naloxone administration Because naloxone is a benign agent in an opioid-naïve child and may potentially improve mental status to the extent that intubation becomes unnecessary, administer a trial dose of 0.1 to 0.2 mg/kg Large amounts of naloxone (up to mg) should be provided before concluding that the intoxication is not responsive to naloxone If effective, it may be necessary to administer repeat doses or a continuous infusion Other pharmacologic agents that have been used in the past include yohimbine, tolazoline, and phentolamine, but evidence for efficacy from these agents has not been demonstrated Digoxin Current Evidence Digoxin is still widely used in young infants with congenital heart disease and elderly patients with congestive heart failure This medication’s continued popularity, its narrow therapeutic index, and the appealing color of digoxin elixir make it a source of many childhood poisoning episodes annually Also, related agents, particularly the foxglove and oleander plants, are occasionally ingested by children, leading to a clinical picture identical to that of digoxin