UMEM Educational Pearls

Category: Toxicology

Title: Xenobiotics That Cause Unusual or Idiosyncratic Reactions in Children

Keywords: benzyl alcohol, clonidine, ethanol, chloramphenicol (PubMed Search)

Posted: 3/9/2011 by Bryan Hayes, PharmD (Emailed: 3/10/2011) (Updated: 3/10/2011)
Click here to contact Bryan Hayes, PharmD

Several medications/chemicals can cause unique toxicologic reactions in pediatric patients.

  • Ethanol: hypoglycemia.  Reported with ethanol levels as low as 20 mg/dL.
  • Clonidine and imidazolines: central nervous system effects.  Agents such as tetrahydrozoline, oxymetazoline, naphazoline, and clonidine can cause CNS depression, respiratory depression, bradycardia, miosis, and hypotension.
  • Benzyl alcohol: gasping syndrome.  Preservative which has been removed from most medications and IV flush solutions used in neonates.  Syndrome includes severe metabolic acidosis, encephalopathy, respiratory depression, and gasping.
  • Chloramphenicol: gray baby syndrome.  Broad-spectrum antibiotic not used frequently in U.S.  Syndrome includes abdominal distension, vomiting, metabolic acidosis, progressive pallid cyanosis, irregular respirations, hypothermia, hypotension, and vasomotor collapse.