Clinical management

  • If the patient presents early (less than 1 hr post ingestion), induce vomiting safely by ensuring the head is lower than the hips (Hansen and Feilberg, 1998)
    Administer activated charcoal to patient who is alert, able to swallow and with gag reflex
  • Although serious toxicity is not expected after ingestion of cetirizine alone,patients with large ingestion of chlorpheniramine may require orotracheal intubation for airway protection to be performed early (National library of medicine, 2009;National library of medicine, 1995)
  • Consider gastric lavage after an extremely large ingestion(greater than 1 g chlorpheniramine) or if more toxic co-ingestants are involved within 2 hours post ingestion, but first protect the airway in cases of sedating antihistamines (National library of medicine, 2009)
    • Gastric lavage is not indicated after small to moderate ingestions if activated charcoal can be given immediately (National library of medicine, 2009)
    • Reverse hyperthermia that results from anticholinergic effects (remove patient clothing, cover with a wet sheet or ice bath water and direct fans at the patient’s skin to enhance evaporation (Textbook of Pediatric Emergency Medicine 6th Ed;National library of medicine, 2009)
    • Administer intravenous boluses of, normal saline, Ringer’s solution, or Ringer’s lactate for hypotension (National Center for Biotechnology Information;National library of medicine, 2009).
    Administer titrated doses of dopamine or other vasopressor amines
    • Treat seizures with diazepam (IV 0.1-0.2mg/kg) or lorazepam (National library of medicine, 2009)
    • Sedate with benzodiazepines (diazepam and lorazepam) for agitation and delirium (National library of medicine, 1995)
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