Dexmedetomidine overdosage: An unusual presentation
A 3-year-old male child, weighing 11 kg and 87 cm in height diagnosed with pyogenic meningitis, was being treated at our facility with intra-venous ceftriaxone and dexamethasone. He was responding well to the treatment. As a result of a clerical error, he was accidentally administered 100 mcg of dexmedetomidine as an intra-venous bolus. Within minutes, he became unconscious, heart rate: 65/min, respiratory rate (RR): 8-10/min, blood pressure: 70/40 mm of Hg, oxygen saturation (SpO2) was 85% and constricted pupils with normal eye reflex []. Auscultation of the chest was unremarkable.\nWith oxygen supplementation by Venturi mask (FiO2 of 0.5), in the next 10 min [] his SpO2 improved to 98% and his RR increased to 14-16/min. As the incident occurred early in the morning, the child was in a fasting state and so deemed at a low risk for aspiration. Considering this and his improved respiratory parameters, endotracheal intubation was deferred. When the patient did not respond to two intra-venous 100 ml bolus of normal saline (10 ml/kg), he was then started on intra-venous infusion of adrenaline 0.04 mcg/kg/min, which was gradually increased to 0.08 mcg/kg/min. His blood pressure gradually improved in the next 1 h to 106/70 mm of Hg and heart rate to 80/min. The dose of adrenaline could be gradually tapered and was finally stopped after 7 h of the dexmedetomidine injection.\nHis blood glucose measured soon after injection of dexmedetomidine was 96 mg/dl and it continued to remain within normal limits.\nSize of the pupils observed in ambient light was found to be 0.5-1 mm approximately. The direct light reflex and consensual light reflex were normal bilaterally. The pupillary size had normalised to 2-2.5 mm by 2 h.\nPatient, unconscious since the bolus injection of dexmedetomidine, started responding to painful stimuli after 3 h. After 4 h, the child started responding to calling by name and after 7 h he became conscious and oriented.