Pediatric clonidine and guanfacine poisoning: a single-center retrospective review

Abstract Clonidine and guanfacine are centrally acting sympatholytics (CAS). Poisoning with these agents is common in children, and management of this poisoning is controversial. We sought to characterize our experience with pediatric CAS poisonings. We used an internal database to identify patients with CAS poisoning seen by the medical toxicology service at our children’s hospital from January 2001 through November 2019. We performed a retrospective chart review. We identified 56 patients with clonidine poisoning and 19 patients with guanfacine poisoning. Sixty-six percent of patients with clonidine poisoning underwent any medical intervention, as did 32% of patients with guanfacine poisoning. The most common interventions were fluids and naloxone. Endotracheal intubation was uncommon. The median hospital length of stay was one day and the median ICU length of stay was one day. Two patients died; one co-ingested a large amount of bupropion and one aspirated charcoal, leading to pneumonitis and anoxic brain injury. No patient with isolated CAS poisoning died. In this retrospective single-center review, pediatric patients tolerated CAS poisoning well. CAS poisoning did not directly result in death. Most pediatric patients with CAS poisoning had short hospital lengths of stay and did not undergo critical care interventions.