Medications that can be fatal for a toddler with one tablet or teaspoonful: a 2004 update.

Objective: To provide an updated list of the highly toxic medications in North America that can kill a 10 kg toddler upon ingestion of 1-2 dose units.

Methods: All drugs available in North America were reviewed and their reported lethal doses in children or adults (where no pediatric data existed) were identified. The dose units of drugs available in North America were subsequently identified, followed by those dose units that could kill a toddler upon ingestion of 1-2 dose units or teaspoonfuls.

Results: Tricyclic antidepressants, antipsychotics, quinine derivatives, calcium channel blockers, opioids, and oral hypoglycemics can kill a toddler with 1-2 dose units. This list of drugs was responsible for 40% of toddler fatalities reported to the American Association of Poison Control Center Toxic Exposure Surveillance System between 1990-2000.

Conclusion: Drugs that can kill a toddler with 1-2 dose units should be known to clinicians as such exposures warrant immediate and intensive management. A new system of special labeling of these drugs should be considered.