Recently, a retrospective study of unintentional buprenorphine/naloxone exposure among pediatric population was published. All patients were evaluated by toxicologists at the time of initial hospital presentation (or transfer) at the study center.

 

Bottom line

• 83% and 80% of the patients experienced respiratory and CNS depression, respectively.

• Majority of the patients became symptomatic within 8 hours of exposure (range not available).

• Naloxone reversed respiratory depression. Median dose for single naloxone dose: 0.09 mg/kg; median dose for multiple naloxone doses: 0.19 mg/kg.

• The reported “ceiling effect” on respiratory depression in adult does not exist in pediatric population.

• The optimal time of observation is unclear but it is prudent to observe pediatric buprenorphine exposure for up to 24 hours.

Additional Information

A retrospective study of single center/referral center’s toxicology consultation service.

88 patients were included. (median age: 24 months [range: 10 to 77 months]). Majority were transferred from other hospitals.

Sources of the medication were

1. Primary caregiver (65%)
2. Other relatives (17%)
3. Parent’s friends (14%)

 

Clinical effects

• Respiratory depression: 83%
• SpO2 < 93%: 28%
• CNS depression: 80%
• Miosis: 77%
• Emesis: 45%
• Agitation: 5%

 

Naloxone

• 55% of the patients received naloxone
• Two patients received naloxone 8 – 12 hours and >12 hours after exposure due to respiratory depression.

The median hospital stay was 22 hours (7 - 248 hours).

• 41% (n = 36) were admitted to ICU.
• The reported exposure dose was the only factor that was significantly associated with length of stay in a multivariate analysis (other variables: sex, age and time to presentation)

 

 

References

_{Clinical effects of unintentional pediatric buprenorphine exposures: experience at a single tertiary care center.}