Guideline‑Referenced Management of Pediatric Benzonatate Overdose

Immediate Toxicology Consultation

Call the national poison‑control center (1‑800‑222‑1222) promptly for expert guidance when a child presents after benzonatate ingestion. This recommendation applies to all pediatric exposures and is based on the Praxis Medical Insights guideline. 1 (Evidence level not specified)

Ensure that bag‑mask ventilation equipment is immediately available for any pediatric patient with suspected benzonatate toxicity. Early readiness is emphasized in the Praxis Medical Insights protocol for rapid deterioration. 1 (Evidence level not specified)

Administer atropine 0.02 mg/kg intravenously or intra‑osseously to pediatric patients with benzonatate‑induced bradycardia or heart block, repeating every 3–5 minutes as needed. This dosing is endorsed by the American Heart Association (Circulation, 2023). 2 (Evidence level not specified)

Give sodium bicarbonate 1–3 mEq/kg intravenously or intra‑osseously for wide‑complex dysrhythmias caused by benzonatate’s sodium‑channel blockade. Recommended by the American Heart Association (Circulation, 2023). 2 (Evidence level not specified)
Prepare a 150 mEq/L sodium bicarbonate solution and infuse at 1–3 mL/kg/h while monitoring electrolytes and acid‑base status. This infusion protocol is part of the same AHA guidance. 2 (Evidence level not specified)

Consider intravenous lipid emulsion (ILE) therapy for refractory cardiovascular shock: give a 1.5 mL/kg bolus (maximum 100 mL) of 20 % lipid emulsion, followed by an infusion of 0.25 mL/kg/min for up to 30 minutes. The American Heart Association includes this lipid rescue strategy for benzonatate toxicity (Circulation, 2023). 2 (Evidence level not specified)