Accidental Drug Ingestion in Children: A Pharmacovigilance Wake-Up Call

Accidental drug ingestion occurs when a child unintentionally consumes a medication, leading to potential toxicity. Young children, particularly those under five years old, are at the highest risk due to their natural curiosity and tendency to explore their environment by putting objects in their mouths. For example, in 2022, 76.4% of all calls to U.S. Poison Control Centers were related to unintentional poisonings, with medications being a significant contributor.

Common Drugs Involved in Accidental Drug Ingestion

Many medications can pose severe risks to children if ingested accidentally. The most common include:

Analgesics: Overdose of opioids such as oxycodone or fentanyl can cause life-threatening respiratory depression. Non-opioid analgesics like acetaminophen may lead to liver toxicity in high doses.

Antidepressants: Medications such as tricyclic antidepressants and SSRIs can lead to cardiac toxicity, seizures, and serotonin syndrome.

Antihistamines: Overdosing on diphenhydramine or other sedating antihistamines can cause extreme drowsiness, agitation, hallucinations, and cardiac arrhythmias.

Benzodiazepines and sedatives: Drugs like diazepam and lorazepam can result in profound sedation, respiratory depression, and coma in children.

Oral hypoglycemics: Medications like sulfonylureas used for diabetes management can cause dangerous hypoglycemia in children.

Beta-blockers and calcium channel blockers: Even small amounts of drugs like propranolol or verapamil can result in severe bradycardia, hypotension, and cardiovascular collapse.

Dietary supplements and herbal products: Some herbal remedies contain active compounds that may be toxic to children.

Case Study: Accidental Levothyroxine Ingestion in a Child

A three-year-old boy ingested 3.2 mg of levothyroxine from his father’s medication and was admitted for observation. He arrived asymptomatic, with stable vitals and a regular systemic examination. The medical team performed gastric lavage and initial tests, including an ECG and thyroid function tests (TFT), which were mainly normal, except for elevated T4 levels.

After 24 hours, he developed tachycardia and high blood pressure (>95th percentile for age). His TFT revealed raised T3, T4, and low TSH levels. The medical team treated him with oral propranolol and prednisolone, stabilizing his heart rate and blood pressure within three days. His vitals, ECG, and blood sugar remained normal.

By day 4, T3 and T4 levels began to decrease. He was discharged on day 5 with safety advice for his parents.

What We Learn from This Case

Levothyroxine is a common household medication, often taken by both adults and children for thyroid conditions. Its appealing color, smell, and taste can make it attractive to young children, increasing the risk of accidental ingestion. If a child is prescribed levothyroxine, it should always be given by a caregiver or under direct supervision, especially for older children who self-administer their medication.

In cases of accidental drug ingestion, immediate medical attention is essential. Healthcare providers may require hospitalization to monitor for signs of toxicity and hyperthyroidism.

Parents and caregivers must remain vigilant and store all medications securely out of children’s reach. Accidental ingestion can lead to serious health complications, making proper medication safety a crucial preventive measure.

The Role of Pharmacovigilance in Preventing Accidental Drug Ingestion

Pharmacovigilance plays a critical role in identifying and mitigating risks associated with accidental drug ingestion in children. Key strategies include:

Child-resistant packaging and clear labeling: While these measures have reduced accidental drug ingestion, improved packaging and warnings are needed for high-risk medications.

Public awareness campaigns: Educating parents and caregivers about the risks of accidental drug ingestion and the importance of proper medication storage.

Monitoring and reporting cases: Continuous surveillance of pediatric poisoning cases helps regulatory agencies identify trends and implement risk-reduction strategies.

Medication reformulation: Developing drugs with taste deterrents and safer toxicity profiles can minimize harm in accidental ingestions.

Conclusion

Accidental drug ingestion in children is a significant public health and pharmacovigilance concern. Strengthening preventive measures, improving drug formulations, and increasing public awareness are essential steps to address this. Furthermore, collaboration between healthcare professionals, regulatory bodies, and pharmaceutical companies is crucial for enhancing drug safety. In doing so, we can better protect children from the dangers associated with accidental medication ingestion.