Phenylephrine and related decongestants: Pediatric poisoning
- Shan Yin, MD, MPH
Shan Yin, MD, MPH
- Assistant Professor of Pediatrics, University of Cincinnati School of Medicine
- Division of Emergency Medicine, Cincinnati Children's Hospital
- Medical Director, Cincinnati Drug and Poison Information Center
- Section Editor
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Phenylephrine and alpha1 adrenergic agonists are common ingredients in over-the-counter (OTC) cough and cold preparations. Phenylephrine is also available as nasal drops. Following overdose in children, these agents have the potential to cause serious toxicity including agitation, hypertension, and cardiac arrhythmias.
This topic will discuss the clinical features, diagnosis, and management of poisoning caused by phenylephrine and related decongestants. Poisoning caused by OTC cough and cold preparations and the use of cough and cold medications in children are discussed separately. (See "Over-the-counter cough and cold preparations: Approach to pediatric poisoning" and "The common cold in children: Management and prevention".)
Pediatric exposures to phenylephrine and related decongestants primarily occur in one of two ways:
●Exploratory ingestion of over-the-counter (OTC) cough and cold medications by a young child (see "Over-the-counter cough and cold preparations: Approach to pediatric poisoning", section on 'Epidemiology')
●Intentional ingestion of dextromethorphan-containing preparations for recreational use (see "Dextromethorphan abuse and poisoning: Clinical features and diagnosis", section on 'Pharmacology and cellular toxicology')
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- PHARMACOLOGY AND TOXICITY
- Mechanism of action
- Toxic dose
- CLINICAL FEATURES AND DIAGNOSIS
- DIFFERENTIAL DIAGNOSIS
- Gastrointestinal decontamination
- Agitation and hypertension
- Hypertensive emergency
- Cardiac arrhythmias
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS