| To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links). |
| Clinical features |
| Symptoms usually appear within 1 hour of oral ingestion of pills or liquids |
| Delayed symptoms may be seen after clonidine transdermal patch exposure |
| May mimic opioid intoxication |
| Common findings: lethargy, coma, bradycardia, hypotension, respiratory depression, apnea, small pupils |
| Diagnostic evaluation |
| Initial evaluation: fingerstick blood glucose (if any alteration in mental status), 12-lead ECG, serum salicylate and acetaminophen levels (if suicidal attempt), pregnancy test (in women of childbearing age) |
| Symptomatic patients: arterial or venous pH and pCO2, serum electrolytes, BUN, creatinine, and chest radiograph if serious and persistent respiratory depression or coma |
| Treatment |
| Remove any transdermal clonidine patches |
| Support airway and breathing |
Respiratory depression or mental status depression - Naloxone, 0.1 mg/kg IV (maximum single dose 2 mg); may repeat every 1 to 2 minutes up to 10 mg total dose in children and opioid naïve adults; for opioid dependent patients, give an initial dose of 0.05 mg IV if spontaneously breathing and 1 mg IV if apneic.
|
Symptomatic bradycardia - 1st line: atropine, 0.02 mg/kg IV (minimum dose: 0.1 mg, maximum single dose: 0.5 mg), repeat after 3 to 5 minutes to maximum total dose of 0.04 mg/kg or 3 mg in adults
- 2nd line: dopamine, initiate IV infusion at 5 to 10 micrograms/kg per minute, titrate to response; maximum dose 20 micrograms/kg per minute
|
Hypotension - 1st line: crystalloid, IV normal saline or Ringer's lactate 20 mL/kg (maximum 1 L), up to 60 to 100 mL/kg (3 to 5 L) total volume
- 2nd line: dopamine, initiate IV infusion at 5 to 10 micrograms/kg per minute, titrate to response; maximum dose 20 micrograms/kg per minute
|
| Do not treat asymptomatic hypertension |
| Administer activated charcoal (AC), 1 gram/kg (maximum dose, 50 grams) to alert patients who present within 1 hour of ingestion unless contraindicated |
| Administer AC 1 gram/kg (maximum dose, 50 grams) followed by nasogastric whole bowel irrigation at 500 mL to 1 L of polyethylene glycol (PEG) per hour in alert patients who have ingested a clonidine transdermal patch, unless contraindicated |
