Abstract

Aim: To describe clinical features, exposure characteristics, management, and outcomes of pediatric atypical antipsychotic poisonings treated in a single tertiary Pediatric Intensive Care Unit (PICU), and to contextualise findings using the Poisoning Severity Score (PSS).
Materials and Methods: We conducted a retrospective, descriptive review of children and adolescents (1 month–18 years) managed for single-agent atypical antipsychotic ingestion at the PICU of Ağrı Training and Research Hospital between January 2018 and January 2023. De-identified electronic records were abstracted for demographics, implicated agent (amisulpride, aripiprazole, quetiapine, olanzapine, risperidone, ziprasidone), dose (mg and mg/kg), time from ingestion to presentation, decontamination (gastric lavage, activated charcoal), treatments (including biperiden), clinical/laboratory findings, and outcomes. Severity was classified by PSS (0–4). Continuous data are reported as median (IQR); categorical data as n (%). Two-sided P < .05 was considered significant.
Results: Forty-one pediatric cases were included. The most frequent agent was risperidone (46.3%). Decontamination included gastric lavage in 43.9% and activated charcoal in 46.3%. Common findings were tachycardia, hypokalemia, confusion, extrapyramidal symptoms (EPS), and drowsiness. PSS distribution was none 14.6%, minor 43.9%, moderate 36.6%, severe 4.9%; no deaths occurred (therefore no PSS grade 4). In a risperidone subgroup analysis (n=19), biperiden was administered to 6 patients for acute EPS; time to presentation tended to be longer in those given biperiden (median 9.0 vs 4.0 hours; p=0.08). Ordinal logistic modelling indicated higher PSS categories in the biperiden group (OR 68.11, 95% CI 3.59–1291.68; p=0.005).
Conclusion: Pediatric atypical antipsychotic poisonings in this cohort were predominantly mild to moderate with no fatalities. Risperidone exposures were most common and frequently associated with EPS, which resolved with biperiden. These data support a generally favourable prognosis with timely supportive care and targeted symptomatic management.

Key words: poisoning; pediatrics; antipsychotic agents; risperidone; biperiden