# Pediatric overdose / poisoning

Support breathing, identify the exposure, and use the toxin-specific pediatric pathway.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-poisoning/
Official source: [SO-P-085 — Substance Overdose / Poisoning - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- Naloxone should not delay ventilation. Monitor for recurrent respiratory depression.
- Atropine doses for poisoning differ from bradycardia doses.

## Source documents

- [SO-P-085 — Substance Overdose / Poisoning - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf)
- [PR-130 — Hydroxocobalamin for Cyanide Toxicity](https://www.ochealthinfo.com/sites/hca/files/import/data/files/85456.pdf)

## Airway, glucose & exposure

- Assist ventilation with BVM and suction as needed. Determine the likely substance, dose, time, route, and any co-exposures; bring useful packaging when safe.
- Check glucose. At 60 mg/dL or less, oral glucose requires intact airway reflexes; D10 is 5 mL/kg IV, maximum 250 mL, or glucagon 0.5 mg IM when IV is unavailable. The IO dextrose exception has additional criteria.

## Opioids or stimulants

- For suspected opioid toxicity with respiratory rate at or below 12/min: naloxone 0.1 mg/kg IN/IM/IV, maximum 1 mg per dose, every 3 minutes as needed. The 4 mg/0.1 mL preloaded nasal spray is a separate fixed product.
- For stimulant toxicity, continuously assess ventilation and SpO₂. Sudden hypoventilation, desaturation, or apnea requires BVM and oxygen. The source lists saline 20 mL/kg IV/IO, maximum 250 mL, with up to three total boluses; assess for hyperthermia and begin cooling when indicated.

## Other named exposures

- Extrapyramidal reaction: diphenhydramine 1 mg/kg IM/IV once, maximum 50 mg.
- Organophosphate/chemical-agent poisoning: atropine 0.02 mg/kg IV, repeat once as needed; alternate IM dose 0.1 mg/kg, repeat after 5 minutes as needed, maximum single dose 2 mg.
- For suspected CO or cyanide exposure, provide high-flow oxygen. PR-130 adds base-ordered hydroxocobalamin for its cyanide indications; do not treat every exposure as cyanide poisoning.

## Reassess & transport

- SO-P-085 permits its listed medications by IO; preserve the separate dextrose exception and indication-specific directions.
- All suspected pediatric overdose/poisoning victims receive ALS escort to the nearest appropriate ERC. Report airway support, serial ventilation findings, exposure details, and all medication totals.