Medication	Treatment
	Adults	Children
Acetaminophen17–20	Treatment based on Rumack-Matthew nomogram (see: http://www.merck.com/mmpe/sec21/ch326/ch326c.html or http://www.ars-informatica.ca/toxicity_nomogram.php?calc=acetamin)	N-acetylcysteine: oral and IV dosing same as for adults, except when using the IV protocol in children weighing less than 88 lb (40 kg); mg per kg dosing same as for adults, with dilution to concentration of 40 mg per mL of N-acetylcysteine using dextrose 5% in water
	N-acetylcysteine: oral loading dose of 140 mg per kg, then 70 mg per kg every four hours for a total of 17 doses
	IV loading dose of 150 mg per kg over 15 to 60 minutes, then 12.5 mg per kg per hour for four hours, then 6.25 mg per kg per hour for 16 hours (use if ingestion occurred less than 10 hours before treatment)
	Treat to clinical end points
Benzodiazepines5	Flumazenil (Romazicon): initial infusion of 0.5 to 5 mg over three to five minutes; titrate to effect Contraindications include history of seizures, chronic benzodiazepine use, coingestion that could induce seizures (e.g., tricyclic antidepressants, cocaine)	Flumazenil: initial infusion of 0.005 to 0.2 mg over three to five minutes; titrate to effect Contraindications (same as for adults)
Beta blockers5,21,22	Glucagon: initial bolus of 50 to 150 mcg per kg; may repeat in three to five minutes, then start infusion at effective dose per hour	Glucagon: initial bolus of 50 to 150 mcg per kg; may repeat in three to five minutes, then start infusion at 0.1 mg per kg per hour
	Calcium gluconate 10% solution: bolus of 0.6 mL per kg over five to 10 minutes, then infusion at 0.6 to 1.5 mL per kg per hour	Calcium gluconate (same as adult dosing)
	Epinephrine: 1 mcg per kg per minute (may need high doses)	Epinephrine: 10 to 30 mcg per minute (may need high doses)
	Insulin “euglycemia” therapy: 1 IU per kg regular insulin plus dextrose bolus of 25 g, then infusion of regular insulin at 0.5 IU per kg per hour with dextrose (0.5 g per kg per hour) and adjust to keep serum glucose level at 100 to 250 mg per dL (5.55 to 13.88 mmol per L)	Insulin “euglycemia” therapy (same as adult dosing)
	Sodium bicarbonate: bolus of 50 mEq of a 1 mEq per mL solution	Sodium bicarbonate: bolus of 1 to 2 mEq per kg if QRS interval greater than 120 milliseconds
Calcium channel antagonists4,21,23	Glucagon, calcium gluconate, epinephrine, insulin euglycemia therapy, or sodium bicarbonate (same dosing as above)	Glucagon, calcium gluconate, epinephrine, insulin euglycemia therapy, or sodium bicarbonate (same dosing as above)
Clonidine (Catapres)4,5,24	Naloxone (formerly Narcan): if no respiratory depression, initial IV dose of 0.1 to 0.4 mg; with respiratory depression, initial IV dose of 1 to 2 mg If no or partial response, then IV dose of 2 mg every three to five minutes for a total of 10 to 20 mg Can also be given intramuscularly	Naloxone: if no respiratory depression, initial IV dose of 0.1 mg per kg (in children younger than five years or weighing less than 44 lb [20 kg]); with respiratory depression, initial IV dose of 2 mg If no or partial response, then IV dose of 2 mg every three to five minutes for a total of 10 to 20 mg Can also be given intramuscularly
	Atropine: 0.5 to 1 mg
		Atropine: 0.02 mg per kg; maximal dose of 0.16 mg
	Dopamine: 5 to 20 mcg per kg per minute	Dopamine: start at 5 mcg per kg per minute, increase by increments of 5 mcg per kg per minute Add norepinephrine if more than 20 mcg per kg per minute of dopamine is needed
Opioids4,5	Naloxone (same dosing as above)	Naloxone (same dosing as above)
Salicylates4,5	Urine alkalinization: three sodium bicarbonate ampules in 850 mL of dextrose 5% solution, with 40 mEq of potassium chloride infused at 2 to 3 mL per kg per hour	Urine alkalinization: sodium bicarbonate solution same as for adults, then infuse at 1.5 to 2 times the calculated maintenance rate
	Consider hemodialysis (based on symptoms; salicylate level of 100 mg per dL or more in acute toxicity or 60 mg per dL or more in chronic toxicity; or if patient requires intubation)	Consider hemodialysis (based on symptoms; salicylate level of 80 mg per dL or more; or if patient requires intubation)
Sulfonylureas4,25–27	Dextrose bolus or infusion with dosing based on degree of hypoglycemia	One month to two years of age: dextrose 25% solution bolus of 2 to 4 mL per kg
		Older than two years: dextrose 50% solution bolus of 1 to 2 mL per kg
	Octreotide (Sandostatin): 50 to 100 mcg per dose subcutaneously two to three times per day	Octreotide: 4 to 5 mcg per kg per day subcutaneously, divided every six hours for maximum of 50 mcg per dose (based on case reports)
	Glucagon: 1 mg per dose; may repeat every 20 minutes as needed (temporary emergent treatment only)	Glucagon: 0.5 mg for children and 0.025 mg per kg per dose for neonates and infants; may repeat every 20 minutes as needed (temporary emergent treatment only) Consider continuous glucose infusion
Tricyclic anti-depressants4,5	Benzodiazepines for seizures (avoid barbiturates and phenytoin [Dilantin]): lorazepam (Ativan), 2 to 4 mg	Benzodiazepines for seizures (avoid barbiturates and phenytoin): lorazepam, 0.05 to 0.1 mg per kg
	Sodium bicarbonate for prolonged QRS interval to maintain pH less than 7.5 (same dosing as above)	Sodium bicarbonate for prolonged QRS interval to maintain pH less than 7.5 (same dosing as above)
	Dopamine (same dosing as above) or norepinephrine: 8 to 12 mcg per minute (adjust to maintain low normal blood pressure)	Dopamine (same dosing as above) or norepinephrine (safety not established in children): 0.1 mcg per kg per minute (adjust to maintain low normal blood pressure); maximum of 6 mcg per minute
	Avoid physostigmine and class IA and IC antidysrhythmics	Avoid physostigmine and class IA and IC antidysrhythmics