Phenergan Supp given to toddler; child dies

tencat · Apr 12, 2007

I see this is an old thread, but really a good one. I learned something about kids and phenergan. That drug makes me nervous with adults, too. I also didn't realize how serious dehydration can be in kids.

I am so sorry about your loss, twinmom. Thank you for sharing with us.:icon_hug:

TazziRN, RN · Apr 13, 2007

My daughter is one that always starts vomiting when she is ill with anything.....it's one of her symptoms of being sick. When she was small and the Phenergan contraindication came out, the docs tried everything with her and nothing else worked. I finally told the docs I would take the risk, to please give her Phenergan. I kept an eagle eye on her each time she got it and has never suffered anything more than drowsiness, but i was willing to take the risk of resp depression rather than having her get sicker because she couldn't stop puking. My doc told me that if I were not a nurse he never would have agreed to it, but knowing what to look for and what to do helped.

EmerNurse, BSN, RN · Apr 13, 2007

My condolences to you and your friend for the loss of a child. I had a somewhat similar experience. My toddler who was 2 1/2 was vomitting in the morning on and off for weeks and we were told by the pediatrician that it was most likely Motrin induced gastritis. I had been giving him motrin and tylenol on and off because he had been cutting molars and kept complaining that his "mouth hurts." After a few more weeks of vomiting we went back to the pediatrician and he gave my son a phenergan injection for the vomiting. He told me it would make him very drowsy for several hours. My son indeed was very drowsy all afternoon and barely woke up to get into pjs for the night and take little fluids so as not to dehydrate. I fully expected him to wake up in the middle of the night ready to go for the day. He did not. At 6:30am when his twin woke up we could not wake the other toddler. He was completely unresponsive. We called the doctors office and 911 and began CPR as he started to turn blue in our arms. He went into respiratory depression and into a coma. We also found out at the same time that he had a brain tumor as well. He went into multiple cardia arrests and respiratory arrests all day long. We took him off of life support two days after. The pediatrician at the childrens hospital was very upset that the pediatrician had given my son phenergan as she said it was contraindicated for a child that small. I realize my child had a terminal illess that we did not know about, but I do believe the respiratory arrest led to his immediate death.
I understand and can sympathize with loss of a child so unexpectedly. Its been very difficult for our family.
God Bless.

My very deepest condolences for your loss. I'll send up a prayer for your little one and your family.

EmerNurse, BSN, RN · Apr 13, 2007

I WAS an RN in NICU (taking some time off to raise a family). I am unfamiliar with Phenergan. Obviously we did not use it in my area.
I have a very tragic situation....A very good friend of mine brought her toddler to our local ER for vomitting and dehydration from viral Gastroenteritis. The child was under two and small for her age (9.5 kg). After waiting more than two hours with symptoms worsening (vomitting blood), her child was given a Phenergan suppository 12.5. No IV was given. No exam was performed. My friend think it was actually the 50 dose based on the color of the packaging and size of the supp. Later, when her daughter coded, the child was given Epinephrine (excessive dose). I have been able to find out that Epi contraindicates with the Phenergan (Lippincott). Her child died. She had me look over the records and the Phenergan stuck out.
What has been your experience with Phenergan supp in pediatric patients? Thanks for your input.....Mom23

Please give my condolences to your friend. How very sad

We don't really give phenergan to kids in our ER - if they've been vomiting, we give IVF and then a PO trial later. Usually, they do pretty well. If we're in doubt, we'll transfer to a peds facility (we don't have inpatient peds).

GoldenLove · Apr 13, 2007

In 2005, the FDA actually made a revision to the safety labeling of promethazine (Phenergan) for use in patients under the age of 2 due to the potential for fatal respiratory depression. We ceased use of it all together after the label change for all patients under 2.

kmoonshine, RN · Apr 15, 2007

First off... The issue with medicine not being equally distributed. Our pharmacy tells us that this is an old school thought and not true at all. They say that it IS evenly distributed... well, according to our pharmacy.
Second... we almost NEVER give phenergan to little ones under 3-- we almost always give TIGAN instead. Less side effects.

Tigan suppositories have been pulled by the FDA as of 04/06/2007:

http://www.fda.gov/medwatch/safety/2007/safety07.htm#trimethobenzamide

I've subscribed to the "e-list" from medwatch and I am sent medical alerts as they become available. I suggest every ED RN subscribe to this.

http://www.fda.gov/medwatch/elist.htm

HM2VikingRN, RN · Apr 15, 2007

Good info

TazziRN, RN · Apr 15, 2007

Tigan suppositories have been pulled by the FDA as of 04/06/2007:
http://www.fda.gov/medwatch/safety/2007/safety07.htm#trimethobenzamide
I've subscribed to the "e-list" from medwatch and I am sent medical alerts as they become available. I suggest every ED RN subscribe to this.
http://www.fda.gov/medwatch/elist.htm

Really?? So what are we supposed to give kids now???

Jennifer, RN · Apr 16, 2007

In the ER that I work at, we give zofran IV or IM to kids and adults. I LOVE this drug. It is a great antiemetic without the sedating properties of other drugs.

katfishLPN · May 12, 2007

My son just got home from the hospital today after a 4 day stay due to rotavirus. :o In his 2nd ER visit the doc wanted to give 12.5mg IV Phenergan to my 60 pound 6 year old. My Ped. will not order it and is totally against it! I also thought that was quite a bit to give. I thought maybe 6.25mg would be better. He had been vomiting for 13 hours straight! I questioned the dose and the nurse came back with a 100mg Tigan supp. I really haven't worked with Tigan so 100mg also seemed like alot to me, also knowing how my ped. feels about antiemetics I was very nervous! But he had been vomiting so long I went ahead with it. Luckily nothing untoward happened but I tell ya those working in the ER have a big responsibility on their hands working with ped patients (and anyone else working with kids!) My son still is not taking adequate po intake and is still having some diarrhea so i am watching him like a hawk! This has been a very informative thread. Thanks to all who have posted!!

luckylucyrn · May 13, 2007

We don't give phenergan in our peds ed hardly at all. I've given it once to a 17 year old. We do po/im/iv zofran.

beachmom · May 15, 2007

All our gastroenteritis peds get boluses and maintenence fluids. NPO until no vomiting for several hours. Then they start on clears and advance diet as tolerated. Occasionally the older ones get Zofran. So far, all my kids have cleared up within a day or two.

(I work in a small hospital, and we usually have only two to three kids at a time.)

I've never given Phenergan to a kid. The adult dosage is 12.5-25 mg. I can't imagine giving that amount to a small child.