Pediatric Monoamine Oxidase Inhibitor Toxicity Workup
- Author: Soumya Ganapathy, MD; Chief Editor: Timothy E Corden, MD more...
See the list below:
- Rapid bedside glucose determination
- ABG determination - Indicated if a compromise in oxygenation or ventilation is suspected
- Lactate level - May be useful in phases 2 and 3 of an acute overdose to help determine end-organ perfusion
- Determination of serum electrolyte, calcium, and magnesium levels - Calculation of the anion gap possibly helpful in screening for co-ingestions (see the Anion Gap calculator)
- Evaluation of serum acetaminophen and salicylate levels - Indicated in intentional overdoses
- Screening for serum levels of alcohol (ethanol, methanol, isopropyl alcohol) - Indicated if alcohol ingestion is clinically suspected
- Urine pregnancy test - Indicated in all women of childbearing age
- Urinalysis and urine pH determination - May be useful in the setting of rhabdomyolysis
- Urine drug screening - Comprehensive drug screening and screening for commonly abused drugs possibly helpful in assessing co-ingestions
- Evaluation of levels of specific monoamine oxidase inhibitor (MAOI) drugs - Not readily available and, therefore, not clinically useful
See the list below:
- Chest radiography is indicated if aspiration is a concern.
- Perform postintubation chest radiography to evaluate the position of the endotracheal tube in relation to the carina if respiratory support is needed.
See the list below:
- Sinus tachycardia is the most common ECG abnormality.
- Nonspecific T-wave changes are also reported.
Endotracheal intubation is required in any patient with a decreasing level of consciousness or signs of impending respiratory failure. Secure the airway before administering activated charcoal or performing gastric lavage in patients with compromised mental status.
Venous access should be obtained. Two large-bore peripheral intravenous lines should be placed in symptomatic patients. Central access may be necessary for the infusion of vasoactive agents.
Gastric lavage is reserved for patients with life-threatening overdoses (2-3 mg/kg) who present within 1 hour of the ingestion. Note the following:
- A large-bore orogastric tube should be used
- Isotonic sodium chloride solution is preferred to water in young children because of the risk of an electrolyte imbalance and water intoxication
- Before proceeding with any decontamination, secure the patient's airway
Foley catheterization of the bladder is indicated to assess urine output, especially in the setting of hemodynamic compromise or rhabdomyolysis.
Arterial line placement is indicated for continuous blood pressure monitoring and frequent blood sampling in patients with a severe ingestion and cardiovascular instability.
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