The Medicine Menace: Children Who Have Swallowed Lethal Doses of Prescription Drugs

Many of the calls that come into Poison Control Centers      concern children who have swallowed over-the-counter pain  relievers or prescription medicines. The Poison Prevention  Week Council strongly urges adults to use child-resistant  packaging for medications – even if there aren’t any children in  the house. Poisonings have happened when children visit  homes, or when people have carried medicines into homes in their pockets or purses.

A study conducted by the American Association of Poison Control Centers found that 23 percent of the oral prescription drugs that were ingested by children under 5 belonged to someone who did not live with the child. Overall, 17 percent of the medicines ingested belonged to a grandparent or great-grandparent. The data suggest that grandparents – and all adults – need to use child-resistant packaging and keep medicines properly secured, away from young children.

«The caps to medicine bottles are child-resistant, not child-proof,» warns Dr. Muller. «Eventually, a child will figure out how to get it open.»

This is the exact scenario that happened in my case.  We were visiting my great-aunt Cora.  Her elderly uncle was staying at her home for an extended visit.  My brothers and cousins and I were upstairs playing in my great-aunt Cora’s bedroom.  In the adjoining room, her uncle  had left his high blood pressure medications on the nightstand.  I had entered the room, removed the cap and was eating the medications like a child would ‘eat candy’.   One of my brothers found me and acted immediately. He told my mother that I ‘was eating chalk’.   My brother was my guardian angel then, and he always has been.

I was 16 months old and my brother was almost three  (3) years old.  My brother went downstairs to get my mother and brought her to the room where I was holding the bottle of blood pressure medications and had chalk residue on my teeth and lips.  I was rushed to the Emergency Room twenty minutes away and they  had to ‘flush my system’ using a variety of uncomfortable procedures.  Being only 16 months old, I don’t remember this story, but everyone who was there that night remembers and are sure to remind me how lucky I am when we are together at family gatherings.  My great-aunt Cora was there that evening.  She was like the lighthouse in our family, sharing memories, and always had a smile and an encouraging word.  My great-aunt Cora, she was a gem!

My mother says that the doctor was livid and gave my parents and their hosts for the evening an extensive and very ‘loud’ lecture on children and prescription medications.  There is not much research that I can find on the topic, but I do know that a lot of the children that accidentally took ‘prescription medications’ did not survive.  I was one of the lucky ones, and my guardian angel is my brother.  He always followed me to and from the school bus and ‘looked out for me’.  Imagine that.  A three year old saving his little sister…and I’ve never forgotten the gift that he gave to me.    Sandy Ej   *2010*

Postscript:  It was determined that the prescription medication was the  lipid-soluble beta-blocker known as propranolol.

These are two websites that provided some information regarding accidental exposure to prescription hypertension and/or cardiovascular medications.

http://www.rxmed.com/b.main/b2.pharmaceu…

http://emedicine.medscape.com/article/81…

The following information has been cited as being from this website:

http://emedicine.medscape.com/article/81…

• Bradycardia with associated hypotension and shock (systolic BP <80 mm Hg, heart rate <60 BPM) defines severe beta-blocker toxicity. Patients with severe toxicity often manifest extracardiac manifestations of intoxication.
  • Bradycardia, by itself, is not necessarily helpful as a warning sign because slowing of the heart rate and damping of tachycardia in response to stress is observed at therapeutic doses.
  • Although case reports have documented hypotension in the absence of bradycardia, blood pressure usually does not fall before the onset of bradycardia.
  • Bradycardia may be isolated or accompanied by mild conduction disturbances.
• A depressed level of consciousness and seizures may occur as a result of cellular hypoxia from poor cardiac output, a direct CNS effect caused by sodium channel blocking, or even as a result of hypoglycemia. The lipid-soluble agents have increased distribution into the brain, and these agents are associated with severe CNS toxicity.
  • Patients who have taken lipid-soluble beta-blockers, such as propranolol, frequently present with seizures after an overdose.
  • Seizures are generalized and may be multiple but are usually brief, lasting seconds to minutes. Seizures occasionally have been reported after therapeutic use of esmolol and with overdose of alprenolol, metoprolol, and oxprenolol. Seizures are far more common after propranolol overdose.
• Coma may be prolonged, depending on the half-life of the agent involved and the coexisting morbidity.
• Severe memory impairment developed in an 81-year-old woman taking propranolol 20 mg 3 times per day. Effects were associated with an elevated propranolol blood level (163 mcg/L) and resolved after discontinuation of the drug.
• Bronchospasm is a rare complication of beta-blocker therapy or overdose but is more likely in patients who already have bronchospastic disease. Sudden fatality following administration of therapeutic doses of beta-blocker has been reported in 4 patients with asthma. Pulmonary edema had been reported to occur as a result of cardiac failure. Respiratory arrest has also been described with beta-blocker intoxication, especially with propranolol, and is thought to be secondary to a central drug effect.
• Hypoglycemia is relatively uncommon but described in patients with unstable diabetes and in children. Beta-blocking drugs may cause hypoglycemia by inhibiting glycogenolysis.

Causes

• Beta-blocker toxicity in children usually results from exposure to an adult’s unattended medications
• Portions of this article written by:          Sandy Ej   *2010*