Spiller Henry A, Klein-Schwartz Wendy, Colvin Jonathan M, Villalobos Danny, Johnson Paul B, Anderson Deborah L
Kentucky Regional Poison Center, Louisville, Kentucky 40232-5070, USA.
J Pediatr. 2005 Feb;146(2):263-6. doi: 10.1016/j.jpeds.2004.09.027.
We performed a prospective case series to seek dosage or clinical parameters to better identify patients who need direct medical evaluation.
All clonidine ingestions in children younger than 12 years of age reported to 6 poison centers were followed for a minimum of 24 hours. Exclusion criterion was polydrug ingestion.
The study included 113 patients, of whom 63 were male. Mean age was 3.8 years (+/-2.4 SD). Clinical effects were common, but severe adverse effects occurred in <10% of patients. The dose ingested was reported for 90 patients (80%); 61 (68%) children ingested <0.3 mg and none had coma, respiratory depression, or hypotension. The lowest dose ingested by history with coma and respiratory depression was 0.3 mg (0.015 mg/kg). Prior clonidine therapy did not affect outcome. Onset of full clinical effects in all cases was complete within 4 hours of ingestion.
We recommend direct medical evaluation for (1) all children 4 years of age and younger with unintentional clonidine ingestion of >or=0.1 mg, (2) ingestion of >0.2 mg in children 5 to 8 years of age, and (3) ingestion of >or=0.4 mg in children older than 8 years of age. Observation for 4 hours may be sufficient to detect patients who will develop severe effects.
我们开展了一项前瞻性病例系列研究，以寻找剂量或临床参数，从而更好地识别需要直接医学评估的患者。
对向6家中毒控制中心报告的所有12岁以下儿童可乐定摄入病例进行至少24小时的随访。排除标准为多药摄入。
该研究纳入了113例患者，其中63例为男性。平均年龄为3.8岁（标准差±2.4）。临床效应常见，但严重不良反应发生在不到10%的患者中。90例患者（80%）报告了摄入剂量；61例（68%）儿童摄入剂量<0.3mg，无一例出现昏迷、呼吸抑制或低血压。有昏迷和呼吸抑制病史的患者摄入的最低剂量为0.3mg（0.015mg/kg）。既往可乐定治疗不影响结局。所有病例在摄入后4小时内完全出现全部临床效应。
我们建议对以下情况进行直接医学评估：（1）所有4岁及以下儿童意外摄入可乐定≥0.1mg；（2）5至8岁儿童摄入>0.2mg；（3）8岁以上儿童摄入≥0.4mg。观察4小时可能足以发现会出现严重效应的患者。
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