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Cardiac monitoring may be necessary with large overdoses.A 12 Lead ECG preformed and assessed for Long QT and arrhythmias.The use of anticholinesterases should be discussed with a toxicologist.Consider repeat ECG at 6 hours if symptomatic. Cardiac monitoring should be instituted and an initial 12 Lead ECG preformed and assessed for Long QT and arrhythmias.Seizures or severe agitation should be treated with benzodiazepines see Seizure.Decontamination - Consider activated charcoal after massive ingestion in older/sedating anti histamines, and within 1 hour / or after airway protection.Monitor level of consciousness and respiratory status and institute supportive measures for respiratory depression or depressed conscious state.In Adolescents, consider investigating for common co-ingestions (paracetamol, alcohol, etc.).Pathology: Paracetamol level in all intentional overdoses.ECG: initially and repeat 4-6 hourly until normal.See Anticholinergic Poisoning Investigations:
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CVS Tachycardia, arrhythmias, Hypotension.Calculate the maximum possible dose per kgĬo-ingestants eg paracetamol Examination:.If possible determine the exact name and tablet size.Presented as syrup, immediate or modified- release tablets.Any child whose developmental age is inconsistent with accidental poisoning as non-accidental poisoning should be considered.All children or young people with intentional self-poisoning or significant accidental ingestion.Acute ingestion of >3 X maximum daily dose.While the current generation of lesser sedating antihistamines do not affect the QT interval at normal doses (unlike the previous generation of medicines), there are concerns there may be some effect in overdose. In overdose symptoms can include dizziness, tachycardia, headache drowsiness or agitation. These medicines cause mostly peripheral H1 blockade with limited penetration into the CNS. Dimenhydrinate-used in combination with hyoscine/caffeine for travel.At higher doses, they can also cause sodium channel blockade with subsequent cardiovascular effects including QT prolongations and Torsades de Pointes. As well as sedation, overdose often presents with anticholinergic symptoms (see Anticholinergic Syndrome). Sedating antihistaminesĪs well as their H1 effect, sedating antihistamines can have alpha adrenergic, anticholinergic and serotonergic effects. In general, the lesser sedating antihistamines have less serious toxicity in overdose. H2 antagonists such as cimetidine and ranitidine are not covered by this guideline.Īntihistamines are divided into sedating and lesser sedating (previous called non-sedating) types. This guideline will only deal with H1 antagonists. Consider investigating for common co-ingestions depending on the formulation, such as paracetamol levels.įor 24 hour advice, contact the Victorian Poisons Information Centre on 13 11 26 BackgroundĪntihistamines are commonly recommended for the treatment of allergic symptoms.Large overdoses of H1 Antihistamines are associated with cardiac arrhythmia and may require close monitoring and specific treatment.The majority of antihistamine poisonings will only require supportive care.Poisoning – acute guidelines for initial management Resuscitation Anticholinergic Poisoning Key points