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Pediatric · Pediatric · ALS

Pediatric overdose / poisoning

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

OCEMS source summary · Updated 2026-09-16

Key cautions & base contact

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

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.