Pediatric Monoamine Oxidase Inhibitor Toxicity Workup

  • Author: Soumya Ganapathy, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Mar 16, 2010
 

Laboratory Studies

  • 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
  • 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
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Imaging Studies

  • 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.
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Other Tests

  • Sinus tachycardia is the most common ECG abnormality.
  • Nonspecific T-wave changes are also reported.
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Procedures

  • Endotracheal intubation may be required.
    • Maintaining a stable airway is the most important step in the management of any toxic ingestion.
    • 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.
    • 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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Contributor Information and Disclosures
Author

Soumya Ganapathy, MD  Department of Emergency Medicine, Beverly Hospital

Soumya Ganapathy, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Frank Anthony Maffei, MD, FAAP  Associate Professor of Pediatrics, Temple University School of Medicine; Medical Director, Pediatric Intensive Care Unit, Janet Weis Children's Hospital at Geisinger Health System

Frank Anthony Maffei, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael E Mullins, MD  Assistant Professor, Division of Emergency Medicine, Washington University in St Louis School of Medicine; Attending Physician, Emergency Department, Barnes-Jewish Hospital

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians

Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

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 School of Medicine, 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.

References

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