What to do if a 2-year-old ingested an unknown quantity of yohimbine (hydrochloride)?

Emergency Management of Yohimbine Ingestion in a 2-Year-Old Child

Immediately call Poison Control at 1-800-222-1222 and seek emergency medical care for a 2-year-old who has ingested an unknown quantity of yohimbine hydrochloride. 1

Immediate Actions

1. Call Poison Control Center (1-800-222-1222)

   • Provide information about the substance (yohimbine HCl), approximate time of ingestion, and child's age/weight
   • Follow their specific instructions while awaiting emergency services 1

2. Seek Emergency Medical Care

   • Do NOT wait for symptoms to appear
   • Do NOT attempt to induce vomiting
   • Do NOT administer activated charcoal unless specifically instructed by Poison Control 1

Clinical Concerns with Yohimbine Ingestion

Yohimbine is an alpha-2 adrenoreceptor antagonist that can cause severe toxicity, particularly in children. Documented cases in adults show blood concentrations of 5,000-7,400 ng/mL have been fatal. 2, 3

Expected Symptoms

• Cardiovascular: Hypertension, tachycardia
• Neurological: Agitation, seizures, altered consciousness
• Gastrointestinal: Vomiting
• Other: Anxiety, tremors 4, 5

Hospital Management

Once at the hospital, the following interventions may be implemented:

1. Airway Management

   • Secure airway with endotracheal intubation if needed
   • Position unconscious child in left lateral head-down position 6

2. Cardiovascular Support

   • Monitor vital signs continuously
   • Treat hypertension with appropriate agents (labetalol, clonidine) 4
   • Manage tachyarrhythmias as needed

3. Neurological Management

   • Treat seizures if they occur
   • Monitor neurological status 4

4. Gastrointestinal Decontamination

   • Gastric lavage may be considered if presentation is within 1-2 hours of ingestion
   • Activated charcoal may be administered if advised by Poison Control 1, 6

Monitoring

• Continuous cardiac monitoring for at least 24-36 hours
• Regular assessment of vital signs and mental status
• Laboratory monitoring of renal and hepatic function 6

Important Cautions

• Do NOT administer anything by mouth unless advised by Poison Control 1
• Do NOT administer syrup of ipecac 1
• Do NOT delay seeking emergency care while attempting home remedies

Prognosis

The severity of yohimbine toxicity is dose-dependent. Case reports document severe toxicity and death in adults with high blood concentrations 4, 2, 3. Given a child's smaller body mass, even a small number of pills could potentially cause significant toxicity.

Early intervention and supportive care are critical for improving outcomes in pediatric poisoning cases.