Cough and Cold Preparation Toxicity Follow-up

  • Author: Laleh Gharahbaghian, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Aug 1, 2011
 

Further Inpatient Care

  • Patients with suspected cough and cold preparation poisoning with persistent or significant hypertension, dysrhythmia, or CNS stimulation require admission for monitoring.
  • The decision to admit the patient to the ICU should be based on the initial presentation, any comorbid diseases, nature and number of the involved agents, and the potential for delayed toxicity.
  • For all intentional overdoses, a psychiatric evaluation is necessary.
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Further Outpatient Care

  • Most regional poison control centers have their own protocols on who may be observed at home; contact them if ingestion has occurred.
  • As a general rule, patients who ingest less than 3 times the maximum daily dose can be observed at home.
  • If symptoms are present (other than mild somnolence) or ingestion is more than 4 times the maximum daily dose, the patient should be referred to a health care facility. The patient should be observed for 4-6 hours following ingestion of liquid and immediate-release solid preparations. Ingestion of sustained-release products may result in delayed onset of symptoms and may require longer periods of observation.
  • If the patient has ingested less than 10 mg/kg of dextromethorphan, the patient can be treated at home. If the patient has ingested a long-acting dextromethorphan, refer the patient to a health care facility for evaluation.
  • If the ingestion was intentional, prompt psychiatric evaluation and admission is warranted.
  • Additional counseling and social work involvement may be required for patients engaging in recreational abuse.
  • Further outpatient treatment should include teaching the patient's caretaker about medication storage and safety.
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Deterrence/Prevention

  • Medications should be labeled and stored safety.
  • Child-resistant closures should be applied to all medications and substances that can cause significant toxicity, such as cough and cold medications.
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Patient Education

  • Patient education is an important part of pediatric toxicology. Half of children who ingested a poison do it again within a year. Review poison prevention techniques with parents. Encourage poison proofing of the home and posting local poison control center telephone numbers by telephones throughout the home.
  • One study showed that only 30% of caregivers who administered acetaminophen were able to demonstrate both accurate measuring and correct dosage for their child.
  • Parents should be taught the following 4 guidelines to prevent future ingestions:
    1. Keep household cleaning products in high locked cabinets rather than under the sink. Safety latches should be place on all kitchen and bathroom cabinets and drawers that contain potentially hazardous substances.
    2. Parents should lock all reachable medicine cabinets, always keep medications in their original (childproof) containers and dispose of unused prescriptions by flushing them down the toilet.
    3. Medication should be considered "medicine," not a toy or candy. Medicine should never be referred to as candy and, if possible, not administered in front of other children. Parents, relatives, and friends also should childproof their homes.
    4. Although ipecac syrup has fallen into disfavor within some medical circles, it is still recommended that parents have it readily available in the home for use with medical direction from a physician or poison control center.
  • In instances of recreational abuse, adolescents and their parents should be counseled on the dangers of addiction, as well as the health risks from dextromethorphan, especially in combination with pseudoephedrine, acetaminophen, and antihistamines.
  • For excellent patient education resources, visit eMedicine's Drug Overdose Center and Poisoning - First Aid and Emergency Center. Also, see eMedicine's patient education articles Poisoning, Drug Overdose, Activated Charcoal, and Poison Proofing Your Home.
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Contributor Information and Disclosures
Author

Laleh Gharahbaghian, MD  Co-Director, Emergency Ultrasound Fellowship, Associate Director, Emergency Ultrasound, Clinical Instructor, Division of Emergency Medicine, Stanford University Medical Center

Laleh Gharahbaghian, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Nicholas Lopez, MD  Attending Physician, Department of Emergency Medicine, Queen of the Valley Medical Center, Sutter Solano Medical Center

Nicholas Lopez, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Jennifer A Oman, MD  Associate Clinical Professor, Department of Emergency Medicine, University of California, Irvine, School of Medicine

Jennifer A Oman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

William T Zempsky, MD  Associate Director, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

William T Zempsky, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

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