Magic mouthwash: Difference between revisions
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;In infants, do NOT use oral lidocaine due to risk of | ;In infants, do NOT use oral lidocaine due to risk of methemoglobinemia and FDA black box warning<ref>FDA recommends not using lidocaine to treat teething pain. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm</ref><ref>Curtis LA, Dolan TS, Seibert HE. Are one or two dangerous? Lidocaine and topical anesthetic exposures in children. J Emerg Med 2009;37:32-39</ref> | ||
==Background== | ==Background== | ||
*Some recommend | *Some experts recommend Magic Mouthwash / oral [[Lidocaine]] in children if not tolerating PO intake, although evidence suggests no better than placebo<ref>Hopper S. et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med. 2014 Mar;63(3):292-9</ref> | ||
==Warnings== | ==Warnings== | ||
*DO NOT EXCEED | *DO NOT EXCEED dosing limits especially for [[lidocaine]]. | ||
*DO NOT use under 2 years old | *DO NOT use under 2 years old | ||
*Never give a family an amount that can be toxic if unintentionally swallowed in its entirety | *Never give a family an amount that can be toxic if unintentionally swallowed in its entirety | ||
===[[Lidocaine]]=== | ===[[Lidocaine]]=== | ||
*1 cc Viscous 2% lidocaine = | *1 cc Viscous 2% lidocaine = 20mg lidocaine | ||
*Max dose = 5mg/kg | *Max dose = 5mg/kg | ||
*For a 10 kg child = | *For a 10 kg child = 50mg lidocaine = 2.5 cc | ||
===[[Diphenhydramine]]=== | ===[[Diphenhydramine]]=== | ||
*[[Diphenhydramine]] 6.25mg/5cc or 12.5mg/5cc | *[[Diphenhydramine]] 6.25mg/5cc or 12.5mg/5cc | ||
*Max dose = 5mg/kg/day | *Max dose = 5mg/kg/day | ||
*For a 10 kg child = | *For a 10 kg child = 50mg benadryl =20 cc of 12.5mg/5cc | ||
==Makeup== | ==Makeup== | ||
Equal parts: | Equal parts: | ||
#Viscous | #Viscous [[lidocaine]] 2% | ||
#[[Diphenhydramine]] | #[[Diphenhydramine]] | ||
#Maalox | #[[Bismuth subsalicylate|Maalox]] | ||
== | *May also omit lidocaine | ||
0.5- | |||
==Management== | |||
0.5-1mL before feeds | |||
==See Also== | ==See Also== | ||
| Line 35: | Line 37: | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pediatrics]] | ||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category: | [[Category:Pharmacology]] | ||
Latest revision as of 19:12, 15 April 2020
- In infants, do NOT use oral lidocaine due to risk of methemoglobinemia and FDA black box warning[1][2]
Background
- Some experts recommend Magic Mouthwash / oral Lidocaine in children if not tolerating PO intake, although evidence suggests no better than placebo[3]
Warnings
- DO NOT EXCEED dosing limits especially for lidocaine.
- DO NOT use under 2 years old
- Never give a family an amount that can be toxic if unintentionally swallowed in its entirety
Lidocaine
- 1 cc Viscous 2% lidocaine = 20mg lidocaine
- Max dose = 5mg/kg
- For a 10 kg child = 50mg lidocaine = 2.5 cc
Diphenhydramine
- Diphenhydramine 6.25mg/5cc or 12.5mg/5cc
- Max dose = 5mg/kg/day
- For a 10 kg child = 50mg benadryl =20 cc of 12.5mg/5cc
Makeup
Equal parts:
- Viscous lidocaine 2%
- Diphenhydramine
- Maalox
- May also omit lidocaine
Management
0.5-1mL before feeds
See Also
References
- ↑ FDA recommends not using lidocaine to treat teething pain. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm
- ↑ Curtis LA, Dolan TS, Seibert HE. Are one or two dangerous? Lidocaine and topical anesthetic exposures in children. J Emerg Med 2009;37:32-39
- ↑ Hopper S. et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med. 2014 Mar;63(3):292-9