Clonidine Poisoning in A Child-A case report

Introduction: Clonidine is among the drugs that are in a list of ‘one pill can kill’ drugs. We are reporting a child with clonidine toxicity with classical manifestations who recovered completely. Case Report: A ۳ year and ۲ months old ADHD girl presented with drowsiness for ۳۰ minutes.  Her mother gave the history of accidental consumption of ۳/۴th clonidine ۱۰۰ mcg tablet ۴۵ minutes prior. On the examination, the child was drowsy with Glasgow Coma Score (GCS) ۱۲/۱۵. Her heart rate was ۸۲ /minute with low volume pulse, respiratory rate ۲۲ /minute, systolic blood pressure was ۸۰ mm of Hg, and diastolic BP was not recordable. Immediately normal saline bolus was administered and her pulse volume improved and BP was ۹۴/۶۰ mm of Hg. After an hour, GCS was ۹/۱۵ and the respiration was shallow. After ۴ hours, her sensorium improved (GCS ۱۵/۱۵). By ۶ hours of ingestion, the child showed complete recovery. Discussion: Most of the clonidine poisoning children were younger than ۶ years according to the NSWPIC database. Among them, ۶۰% developed symptoms, most commonly lethargy (۸۰%), bradycardia (۱۷%), hypotension (۱۵%), and respiratory depression (۵%). Symptoms usually develop within ۳۰-۶۰ minutes and resolve within ۲۴-۴۸ hours. In our case, classical symptoms like drowsiness, hypotension, meiosis occurred within ۳۰ minutes of ingestion and her consciousness deteriorated along with shallow respiration by the next ۲ hours. By ۶ hours of ingestion, the child showed complete recovery. Conclusion: While prescribing clonidine caution should be exercised regarding the side-effects. When calculating the dose, extra vigilance should be ensured and drug needs to be kept out of the reach of children.

Keywords:

Clonidine , Toxicity , Drowsiness , Hypotension , Respiratory Depression