Management of Phenazopyridine Overdose in Children

Initial Assessment and Stabilization

Establish and maintain an open airway as the first priority, providing bag-mask ventilation for respiratory depression, followed by endotracheal intubation when appropriate, according to the American Heart Association, as reported in Circulation 1
Contact a regional poison center immediately for expert guidance in management, as recommended by the American Heart Association, as reported in Circulation 1
Monitor vital signs continuously, with particular attention to oxygen saturation, heart rate, blood pressure, and respiratory status, as advised by the American Heart Association, as reported in Circulation 1

Administer methylene blue 1-2 mg/kg intravenously for symptomatic patients with methemoglobin levels >20% or any patient with levels >30%, as recommended by the American Heart Association, as reported in Circulation 1

The maximum cumulative dose of methylene blue should not exceed 7 mg/kg to avoid methylene blue-induced hemolysis, as recommended by the American Heart Association, as reported in Circulation 1