• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.1
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• pp.27-31
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• 2011

We report two cases of accidental overdoses of intramuscular midazolam used for a conscious sedation. A 4-year-old boy with dental caries was scheduled for treatment under conscious sedation. The pedodontist prescribed midazolam ($dormicum^{(R)}$ 5 mg / 5 ml) 2 ml (2 mg) by verbal order to hygienist. The hygienist instead of the pedodontist wrote a prescription for midazolam ($dormicum^{(R)}$ 15 mg / 3 ml) 2 ml (10 mg). The inexperienced nurse gave an injection to his buttock as prescription. The child fell into a deep sedation. A 4-year-old boy with dental caries was scheduled for treatment under conscious sedation. The inexperienced pedodontist gave an injection to his buttock midazolam ($dormicum^{(R)}$ 15 mg / 3 ml) 3 ml (15 mg) instead of midazolam ($dormicum^{(R)}$ 5 mg / 5 ml) 3 ml (3 mg). The child fell into a deep sedation. Both cases had no complications, but the accidents happened as a result of the inexperienced dental staffs. The five times midazoalm instead of the intended doses was inadvertently given intramuscularly, fortunately caused no harm in our cases. However, the situations suggest that we should carefully check the dosage and review the correct procedures, even when using a drug that is considered to be familiar with most practitioners.

• Proceedings of the PSK Conference
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• 2002.10a
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• pp.285-285
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• 2002

Diazepam (DZ) is one of the most frequently prescribed drugs as an antianxiety agent. muscle relaxant. and anticovulsant and sometimes causes intoxication due to accidental overdose, misuse or abuse. DZ is metabolized to nordiazepam (NDZ, desmethyldiazepam), oxazepam (OX) and temazepam (TM) which are also pharmacologically active, although OX and TM do not accumulate in blood or plasma to an appreciable extent. (omitted)

• Proceedings of the PSK Conference
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• 2003.10b
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• pp.118.3-119
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• 2003

Diazepam (DZ) is one of the most frequently prescribed drugs as an antianxiety agent, muscle relaxant, and anticovulsant and sometimes causes intoxication due to accidental overdose, misuse or abuse. Screening or confirmation methods for DZ and NDZ in plasma are very important for clinical and toxicological studies and in forensic cases. GC/MS assay with SPE was developed for the determination of diazepam and its metabolite, nordiazepam in human plasma. Diazepam in plasma was extracted by a rapid and sensitive procedure based on C18 bonded-phase extraction. (omitted)

• Clinical and Experimental Pediatrics
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• v.51 no.11
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• pp.1232-1235
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• 2008

Imipramine, a tricyclic antidepressant (TCA), is used for the treatment of non-polar depression and nocturnal enuresis in children in whom an organic pathology has been excluded, anxiety disorders, and neuropathic pain. Clinical toxicity following the treatment of TCAs, including imipramine, is well known. The anticholinergic effects initially present include a dry mouth, ileus, dilated pupils, urinary retention, and mild sinus tachycardia. The central nervous system toxicity includes delirium, agitation, restlessness, hallucinations, convulsions, and CNS depression or coma. However, the most life-threatening toxicity remains the development of cardiac dysrhythmias. Conduction delays such as QRS and corrected QT prolongation, wide QRS complex tachycardia, and the Brugada electrocardiographic pattern have been reported. Sodium bicarbonate decreases QRS widening and suppresses dysrhythmias by providing excess sodium to reverse the TCA-induced sodium-channel blockade and possibly by binding directly to the myocardium. There are no pediatric case reports on imipramine or other TCA associated toxicity in Korea. Here, we describe a patient who presented with convulsions, tachycardia with a wide QRS complex, a Brugada electrocardiographic pattern, and anuresis associated with an accidental overdose of imipramine and the outcome of treatment with sodium bicarbonate.