TY - JOUR
KW - Analgesics, Opioid/poisoning
KW - Antidotes/administration & dosage
KW - Buprenorphine/poisoning
KW - Buprenorphine, Naloxone Drug Combination/poisoning
KW - Charcoal/administration & dosage
KW - Child
KW - Child, Preschool
KW - Cohort Studies
KW - Female
KW - Hospitalization/statistics & numerical data
KW - Humans
KW - Infant
KW - Length of Stay
KW - Male
KW - Narcotic Antagonists/poisoning
KW - Oximetry/methods
KW - Oxygen/metabolism
KW - Respiratory Insufficiency/chemically induced/epidemiology
KW - Retrospective Studies
KW - Time Factors
KW - poisoning
KW - Injury prevention
KW - Opioids
KW - Overdose
AU - Michael S. Toce
AU - Michele M. Burns
AU - Katherine A. O'Donnell
A1 - 
AB - CONTEXT: Exploratory buprenorphine ingestions in young children have been associated with clinically significant toxicity. However, detailed data on the clinical presentation and management of these patients are lacking. In an attempt to obtain more comprehensive data, we sought to examine a single center cohort of patients with report of buprenorphine exposure and provide descriptive analysis of rates of respiratory depression, time to respiratory depression, interventions, disposition, and outcomes. STUDY DESIGN: We performed a retrospective cohort study at a single pediatric tertiary care center of children between the age of 6 months and 7 years of age hospitalized between 1 January 2006 and 1 September 2014 with report of buprenorphine or buprenorphine/naloxone exposure. Patients with possible exposure to more than one agent were excluded. We extracted clinical findings, including time to respiratory depression, interventions, and disposition from the medical record. RESULTS: Eighty-eight patients met the inclusion criteria. Seven patients were excluded. The median age was 24 months [IQR 18-30]. 20 patients (23%) received activated charcoal while 48 (55%) were treated with naloxone. 36 (41%) patients were admitted to the ICU. Observed clinical effects included respiratory depression (83%), oxygen saturation by pulse oximetry (SpO2) < 93% (28%), depressed mental status (80%), miosis (77%), and emesis (45%). Median time from exposure to respiratory depression was 263 min [IQR 105-486]. The median hospital length of stay was 22 h [IQR 20-26] and was positively associated with estimated exposure dose (p = 0.002). CONCLUSION: Pediatric patients exposed to buprenorphine are likely to exhibit signs and symptoms of opioid toxicity, including respiratory depression, altered mental status and miosis. Although the majority of patients developed signs of clinical toxicity within 8 h of reported exposure, the optimum duration of monitoring remains unclear.
AD - a Harvard Medical Toxicology Program , Boston Children's Hospital , Boston , MA , USA.; a Harvard Medical Toxicology Program , Boston Children's Hospital , Boston , MA , USA.; b Division of Emergency Medicine, Department of Medicine , Boston Children's Hospital , Boston , MA , USA.; a Harvard Medical Toxicology Program , Boston Children's Hospital , Boston , MA , USA.; c Division of General Pediatrics, Department of Medicine , Boston Children's Hospital , Boston , MA , USA.
BT - Clinical toxicology (Philadelphia, Pa.)
C5 - Healthcare Disparities; Opioids & Substance Use
CP - 1
CY - England
DO - 10.1080/15563650.2016.1244337
IS - 1
JF - Clinical toxicology (Philadelphia, Pa.)
LA - eng
M1 - Journal Article
N2 - CONTEXT: Exploratory buprenorphine ingestions in young children have been associated with clinically significant toxicity. However, detailed data on the clinical presentation and management of these patients are lacking. In an attempt to obtain more comprehensive data, we sought to examine a single center cohort of patients with report of buprenorphine exposure and provide descriptive analysis of rates of respiratory depression, time to respiratory depression, interventions, disposition, and outcomes. STUDY DESIGN: We performed a retrospective cohort study at a single pediatric tertiary care center of children between the age of 6 months and 7 years of age hospitalized between 1 January 2006 and 1 September 2014 with report of buprenorphine or buprenorphine/naloxone exposure. Patients with possible exposure to more than one agent were excluded. We extracted clinical findings, including time to respiratory depression, interventions, and disposition from the medical record. RESULTS: Eighty-eight patients met the inclusion criteria. Seven patients were excluded. The median age was 24 months [IQR 18-30]. 20 patients (23%) received activated charcoal while 48 (55%) were treated with naloxone. 36 (41%) patients were admitted to the ICU. Observed clinical effects included respiratory depression (83%), oxygen saturation by pulse oximetry (SpO2) < 93% (28%), depressed mental status (80%), miosis (77%), and emesis (45%). Median time from exposure to respiratory depression was 263 min [IQR 105-486]. The median hospital length of stay was 22 h [IQR 20-26] and was positively associated with estimated exposure dose (p = 0.002). CONCLUSION: Pediatric patients exposed to buprenorphine are likely to exhibit signs and symptoms of opioid toxicity, including respiratory depression, altered mental status and miosis. Although the majority of patients developed signs of clinical toxicity within 8 h of reported exposure, the optimum duration of monitoring remains unclear.
PP - England
PY - 2017
SN - 1556-9519; 1556-3650
SP - 12
EP - 17
EP - 
T1 - Clinical effects of unintentional pediatric buprenorphine exposures: experience at a single tertiary care center
T2 - Clinical toxicology (Philadelphia, Pa.)
TI - Clinical effects of unintentional pediatric buprenorphine exposures: experience at a single tertiary care center
U1 - Healthcare Disparities; Opioids & Substance Use
U2 - 27756148
U3 - 10.1080/15563650.2016.1244337
VL - 55
VO - 1556-9519; 1556-3650
Y1 - 2017
Y2 - Jan
ER -