SMALL DOSES, BIG PROBLEMS - A SELECTED REVIEW OF HIGHLY TOXIC COMMON MEDICATIONS

Serious childhood poisonings are usually associated with the ingestion of a drug or substance in an excessive dose or with a prescription medication (usually belonging to an adult) that has serious effects when taken by an infant or child. It is important for the pediatrician and emergency physician to be aware of several medications that are toxic and, occasionally, lethal in very small doses. This review will focus on five such medications—methyl salicylate, camphor, topical imidazolines, benzocaine, and diphenoxylate-atropine—because they are commonly used and are easily available. (All but one are over-the-counter drugs). Furthermore, all of these products (with the exception of diphenoxylate-atropine) lack safety closures and thus are easily ingested by children. Discussion will focus on the sources of these poisons, their range of toxicity, clinical manifestations, medical evaluation, and appropriate therapy. Awareness of the toxic potential of these medications is necessary to ensure prompt recognition and aggressive management, so that serious or fatal consequences can be avoided. © 1993 Williams and Wilkins.