Clonidine Poisoning in A Child-A case report

Clonidine is among the drugs that are in a list of ‘one pill can kill’ drugs. We are reporting a child with clonidine toxicity with classical manifestations who recovered completely.

Case Report: 

A 3 year and 2 months old ADHD girl presented with drowsiness for 30 minutes.  Her mother gave the history of accidental consumption of 3/4th clonidine 100 mcg tablet 45 minutes prior. On the examination, the child was drowsy with Glasgow Coma Score (GCS) 12/15. Her heart rate was 82 /minute with low volume pulse, respiratory rate 22 /minute, systolic blood pressure was 80 mm of Hg, and diastolic BP was not recordable. Immediately normal saline bolus was administered and her pulse volume improved and BP was 94/60 mm of Hg. After an hour, GCS was 9/15 and the respiration was shallow. After 4 hours, her sensorium improved (GCS 15/15). By 6 hours of ingestion, the child showed complete recovery.

Most of the clonidine poisoning children were younger than 6 years according to the NSWPIC database. Among them, 60% developed symptoms, most commonly lethargy (80%), bradycardia (17%), hypotension (15%), and respiratory depression (5%). Symptoms usually develop within 30-60 minutes and resolve within 24-48 hours. In our case, classical symptoms like drowsiness, hypotension, meiosis occurred within 30 minutes of ingestion and her consciousness deteriorated along with shallow respiration by the next 2 hours. By 6 hours of ingestion, the child showed complete recovery.

While prescribing clonidine caution should be exercised regarding the side-effects. When calculating the dose, extra vigilance should be ensured and drug needs to be kept out of the reach of children.