Case series: Clinical management strategies of pediatric clonazepam poisoning informed by pharmacokinetics

This study aimed to investigate the clinical manifestations of pediatric clonazepam poisoning and to analyze treatment strategies based on its pharmacokinetic characteristics, thereby providing evidence for the clinical management of such cases. A retrospective analysis was conducted on four pediatric patients with clonazepam overdose admitted to our hospital between January 1 and December 31, 2024. Clinical data, including demographic information, clinical manifestations, treatment procedures, and outcomes, were collected and analyzed. Rescue strategies were evaluated in conjunction with the pharmacokinetic properties of clonazepam. All four children presented with varying degrees of dizziness, vomiting, and ataxia following clonazepam ingestion. Gastric lavage was promptly performed in all cases upon hospital admission. Cases 1 and 3 received the specific antidote flumazenil, while cases 1 and 2 underwent hemoperfusion and combined hemoperfusion-continuous venovenous hemofiltration therapy, respectively. All cases achieved complete recovery. Notably, in the two cases treated with hemoperfusion, plasma clonazepam concentrations declined more rapidly than the theoretical elimination time, suggesting that extracorporeal blood purification may facilitate drug clearance in cases of high-dose poisoning. Pediatric clonazepam poisoning is primarily characterized by dose-dependent central nervous system depression. In cases involving large doses or multiple drug overdoses, hemoperfusion may be considered on a case-by-case basis to help reduce plasma drug concentrations; however, further studies are required to confirm its clinical efficacy. Additionally, greater attention to adolescent mental health-particularly during puberty-and enhanced education on medication safety are essential to prevent such poisoning incidents.