Pediatric Ingestion of Angiotensin II Receptor Antagonists: What's the Risk?

Objectives: Angiotensin-II receptor blockers (ARB) prevent the binding of angiotensin II to the AT1 receptor subtype. The antihypertensive effect of the different sartans seems to be relatively comparable. Only few data are available about toxicity in childhood (1). Case series: Retrospective analysis of pediatric ingestions was done in a cooperation of the poison centers GIZ-Berlin (1/1996-10/2007) and VIZ-Freiburg (5/2000-10/2007). Inclusion criteria were: age 0-13 years, known ingestion and dose, follow-up information available. Dose was reported as defined daily dose (DDD) to express equipotent doses of the different ARB's referring to normal adult dose. Severity of poisoning was rated according to PSS (2). Results: 81 children, age 0.8-13 years (median 2), DDD 0.25 - 26 (median 1). Children were observed in health care facility (73) or at home (8). Substances ingested were candesartan (39), eprosartan (2), irbesartan (8), losartan (9), olmesartan (6), telmisartan (7), valsartan (10). After ingestion of less than 1 DDD no child developed symptoms (21). Severity of poisoning was minor (2) or asymptomatic (43) after ingestion of 1-2 DDD. 15 children ingested more than 2 DDD. 5 of them developed minor symptoms. Hypotension requiring therapy was reported in one case (6 DDD). Latency between onset of symptoms and ingestion was