The nurse is caring for an irritable, lethargic 18-month-old child who swallowed several over-the-counter (OTC) antihistamine tablets an hour ago. What intervention should the nurse implement?

• A. Initiate gastric lavage.
• B. Administer naloxone.
• C. Give a dose of ipecac syrup.
• D. Encourage oral intake of water or milk.

Answer: (B)

Overdose from OTC antihistamines like diphenhydramine is managed with supportive care rather than a specific antidote. The main focus is protecting the airway and supporting breathing and circulation while monitoring for anticholinergic and sedative effects. There is no antidote that reverses antihistamine toxicity, so giving an antidote such as naloxone would not help in this case. Naloxone reverses opioid effects, not antihistamine effects, so it’s not indicated here.

Gastric decontamination methods like gastric lavage or inducing vomiting with ipecac are not routinely used, especially in a lethargic child because of the risk of aspiration and lack of demonstrated benefit. Encouraging oral intake is inappropriate while the child is at risk for aspiration and unable to protect the airway.

The nurse should prioritize airway protection, continuous monitoring, IV access, and supportive measures (fluids, careful observation of mental status, seizure precautions if needed) and consult poison control for tailored guidance. If ingestion was very recent and the patient can protect the airway, activated charcoal might be considered, but the immediate priority remains supportive care.