A 3-year-old (14 kg) is found unconscious next to empty bottles of his grandmother's medications. He has pinpoint pupils, respiratory rate of 6/min, and oxygen saturation of 82%. After securing the airway and starting bag-mask ventilation, which of the following is the most appropriate next step?
- A IV flumazenil 0.2 mg
- B IV N-acetylcysteine 150 mg/kg
- C IV naloxone 0.1 mg/kg (up to 2 mg) ✓
- D IV sodium bicarbonate 1 mEq/kg
Correct answer: C. IV naloxone 0.1 mg/kg (up to 2 mg)
Explanation
Pinpoint pupils, respiratory depression, and decreased consciousness are classic for opioid poisoning. Naloxone is the specific antidote. The pediatric dose is 0.1 mg/kg IV (maximum 2 mg per dose), repeated as needed. Flumazenil is for benzodiazepines. NAC is for paracetamol. Sodium bicarbonate is for tricyclic antidepressant or salicylate poisoning.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.