ED visits rising for ODs of cold and cough meds
Signs and symptoms vary widely
More than 7,000 children visit EDs each year with symptoms such as hives, drowsiness, or unsteady walking caused by taking over-the-counter and prescription cough and cold medications, according to a new study from the Centers for Disease Control and Prevention.1
Researchers looked at case reports of children 11 and younger treated for overdoses at 63 EDs in 2004 and 2005, and they found that two-thirds of the cases involved children taking medicines unsupervised. Twenty-five percent of the cases involved parents giving the correct dosage with an allergic reaction or adverse outcome occurring.
About 1,600 of the estimated 7,100 cases involved children younger than age 2, and nearly two-thirds of the cases involved children ages 2 to 5. Because the researchers didn't follow the cases, it's unknown if any deaths resulted.
The Food and Drug Administration (FDA) has warned parents that liquid cough and cold medicines are unsafe and ineffective when used in children younger than two. The FDA says risks include depressed respiration, rapid heart rate, and seizures, with four deaths reported last fall associated with cough or cold medicines given to babies. The FDA is developing recommendations for the use of cold and cough medicines in children ages 2 to 11.
"New medical information is always a challenge, and the cold medication issue is no exception," says Michelle Moegling, RN, BSN, ACN, pediatric emergency clinical educator at Rainbow Babies and Children's Hospital in Cleveland.
The ED admitted four children with a chief complaint of cough and cold medication overdose last year, says Moegling. "There may be more cases, in that we see about 10-15 'fussy' babies under age 1 each year that we suspect may have been given cold medicines or too much cold medicine," she says. "This theory goes unproven, since there are many variables in caretakers and history."
Signs and symptoms of overdose vary widely depending on the type of medication, says Moegling. A child with an antihistamine overdose may present with fussiness, confusion, and dry, flushed skin, she says. An overdose of cough suppressants may cause hallucinations, enlarged pupils, ataxia, hypertension and seizures, Moegling says. Children who overdose on nasal decongestants may present as pale, agitated, and sweaty, she says.
Ask these questions at triage, says Moegling:
Is your child on any medications?
Do you have the medicine with you? (If the patient answers no, ask, "Do you know how much medicine is in each dose?")
What dose are you giving and how often?
When was the last dose given?
Are there any other medications in the house that the child could have ingested?
Don't overlook acetaminophen OD
Acetaminophen is an ingredient in many cold and cough remedies, which can be a significant problem, says Mary Thacher, RN, BSN, CEN, SANE-A, emergency services director at Emory Johns Creek Hospital in Johns Creek, GA.
"You will not see signs or symptoms of an acetaminophen overdose for two days," she says. "By the time the patient becomes symptomatic, liver damage has already occurred."
Gastric contamination and lab work are needed to be sure there is no acetaminophen overdose, although gastric decontamination has little benefit if more than two hours have elapsed since ingestion, says Thacher. "An acetaminophen overdose can most certainly be overlooked, because there are generally no symptoms," she says. "That is why lab work is crucial if it is suspected."
ED nurses recently cared for a drowsy 8-year-old girl who overdosed on cough syrup containing dextromathorphan, an opioid-like medication that can cause somnolence, nystagmus, altered mental status, and depressed respirations.
"Assessing airway status was our biggest concern. We observed her for about six hours to make sure she did not have any airway concerns and also had her drink charcoal," says Thacher. "Our patient did not have any acetaminophen in her cough syrup and was able to be discharged home."
Reference
- Schaefer MK, Shehab N, Cohen AL, et al. Adverse events attributable to cough and cold medications in children. Pediatrics. Published online Jan. 28, 2008 (doi:10.1542/peds.2007-3638).
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