II. Pathophysiology

  1. See Clonidine
  2. Clonidine acts at two sites
    1. Central Acting Adrenergic Agonists (alpha-2 receptors)
    2. Imidazoline receptors

III. Causes

  1. Imidazoline Poisoning
    1. Clonidine Overdose (including Clonidine patch)
    2. Child ingestion of topicals: Oxymetazoline (Afrin), Naphazoline (Visine)
    3. Dexmedotomidine (e.g. veterinary Anxiolytic medications)

IV. Findings: Signs and Symptoms

  1. Apnea
  2. Bradycardia
  3. Coma
  4. Hypertension or Hypotension
  5. Hypothermia
  6. Mental status change
  7. Pinpoint Pupils (Miosis)
  8. Respiratory Depression

V. Management: Adults

  1. ABC Management
  2. Naloxone
    1. Indicated in respiratory depression and apnea or significant CNS depression
    2. Initial
      1. No respiratory depression: 0.1 to 0.4 mg IV or IM
      2. Respiratory depression: 1 to 2 mg IV or IM
    3. Next, if no response or incomplete response
      1. Give 2 mg IV or IM every 3-5 minutes to a total of 10 mg total maximum
      2. Redosing may be needed due to short naloxone Half-Life
  3. Atropine
    1. Indicated in severe Sinus Bradycardia
    2. Atropine 0.5 to 1 mg IV (may repeat after 3 to 5 min, up to a maximum total dose of 3 mg)
  4. Vasopressors
    1. Indicated for Hypotension refractory to Intravenous Fluids
    2. Norepinephrine or Epinephrine IV

VI. Management: Children

  1. ABC Management
  2. Naloxone
    1. Initial
      1. No respiratory depression: 0.1 mg/kg to 0.4 mg IV or IM
      2. Respiratory depression: 1 to 2 mg IV or IM
    2. Next, if no response or incomplete response
      1. Give 2 mg IV or IM every 3-5 minutes to a total of 10-20 mg
  3. Atropine
    1. Indicated in Severe Bradycardia
    2. Start: Atropine 0.02 mg/kg up to 0.16 mg IV
    3. Maximum: Atropine 0.5 mg/kg IV
  4. Vasopressors
    1. Indicated for Hypotension refractory to Intravenous Fluids
    2. Norepinephrine or Epinephrine IV

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Clonidine overdose (C0573261)

Concepts Injury or Poisoning (T037)
SnomedCT 296389000
English clonidine overdose, Clonidine overdose, Clonidine overdose (disorder)
Spanish sobredosis de clonidina (trastorno), sobredosis de clonidina