Phenothiazine, butyrophenone, and other psychotropic medication poisoningsin children and adolescents

Objective: To describe the presentation, epidemiology, management, and outc ome of phenothiazine and butyrophenone ingestions in children requiring hos pitalization. Method: Retrospective case series in two pediatric hospitals, Results: Eighty-six cases were identified among 83 patients. The majority (69.7%) of ingestions occurred in children <6 years of age and there was no gender predominance, These ingestions mere more common in African American s (65.1%), They occurred more commonly in the patient's (64.0%) or a relati ve's (22.1%) home and haloperidol and thioridazine accounted for 58.1% of e xposures. Depressed levels of consciousness and dystonia were the most comm on presenting signs, present in 90.7% and 51.2% of patients, respectively. Miosis occurred in only 13.9% of the patients. Fluid boluses were administe red to 28.7% of the patients but about a quarter of these had coingested po tentially cardiotoxic drugs, In addition, 2 of the 12 (13.9%) patients with abnormal electrocardiograms had also ingested potentially cardiotoxic drug s. Numerous diagnostic tests were performed in these patients including ele ctrolyte panels (80.2%), complete blood counts (69.8%), liver function test s (31.4%), serum osmolality (20.9%), blood cultures (10.5%), lumbar punctur es (17.4%), head computed tomographies (15.1%), and electroencephalograms ( 3.5%). The median length of hospitalization was 1.78 (range 1-9) days and t here were no deaths. Patients presenting with dystonias were more likely to have extensive diagnostic testing for neurologic disease than those presen ting without dystonias, Conclusion: The presentation of phenothiazine and b utyrophenone ingestions in children and adolescents may be nonspecific and confounded by coingestants, Patients with dystonias had more extensive neur ologic testing than patients without dystonias, suggesting that physicians may not recognize dystonias as a clinical finding characteristic of phenoth iazine or butyrophenone exposure.