Pediatric poisoning from trimedoxime (TMB4) and atropine automatic injectors
Received 28 March 2004; received in revised form 2 July 2004; accepted 23 August 2004.
Objective
To describe the effects of combined trimedoxime (TMB4) and atropine poisoning from automatic injectors (AI) in children.
Study design
Data was collected from two sources: calls to the Israel Poison Information Center (IPIC) during a 1-year period and a cohort of children who presented to pediatric emergency departments (EDs) after unintentional injection of an AI. Demographic data and data regarding the type of AI, site and time of injection, and the clinical manifestations were abstracted.
Results
Data were available for 142 patients. The median age was 8.5 years (range 1.25-18 years). The dose of atropine and TMB4 was higher than the recommended dose for age in 22 (15.5%) cases. There were few side effects attributable to atropine: dilated pupils (26.7%), dryness of mucous membranes (24.6%), and tachycardia (22.5%). Compared with children injected with an age-appropriate dose, children injected with an AI that contained a dose that exceeds the recommended one were more likely to be symptomatic (P=.029). There were no side effects characteristic to oximes, and no specific medical intervention was required.
Conclusions
Unintentional pediatric atropine and TMB4 injection, even an adult dose in a small child, does not cause significant side effects.
From the Department of Emergency Medicine, and the Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Sakler Faculty of Medicine, Tel Aviv University; and the Israel Poison Information Centre, The Bruce Rappaport Faculty of Medicine, Rambam Medical Center, Technion, Israel
Reprint requests: Eran Kozer, MD, Assaf Harofeh Medical Center, Pediatric Emergency Services, Zerifin 70300, Israel.
Presented in part at the North American Congress of Clinical Toxicology, Chicago, Illinois, September 2003, and at the second Mediterranean Emergency Medicine Congress, Sitges/Barcelona, Spain, September 2003.
ABSTRACT