Professional Documents
Culture Documents
Poisoning in Childhood
Definition of Poisoning:
Exposure to a chemical or other agent that adversely
affects functioning of an organism.
ABCs of Toxicology:
Airway
Breathing
Circulation
Drugs:
Resuscitation medications if needed
Universal antidotes
Draw blood:
chemistry, coagulation, blood gases, drug levels
Decontaminate
Expose / Examine
Full vitals / Monitoring
Give specific antidotes / treatment
Decontamination:
1.Ocular:
Flush eyes with saline
2.Dermal:
Remove contaminated clothing
Brush off
Irrigate skin
3.Gastro-intestinal:
Activated charcoal:
May Prevent /delay absorption of some drugs/toxins
Almost always indicated
Naso/oro-gastric Lavage
Bowel Irrigation:
Recent ingestions 4-6 hrs
500 cc NS Children / 2000cc adults
Orally / Nasogastric tube
poising Treatment
Do not induce vomiting
Do not attempt gastric lavage
Risk of aspiration outweighs any benefit from
removal of substance
CXR around 2-4 hrs not before 2hrs
Observe in ER for 6-8 hrs
Preventing
Epidemiology
Clinical features
Investigation
Treatment
Clinical features
Age 1 to 3 years
more than 70% symptomatic within
10 hours
SYMPTOMS
RS breathlessness, cough
CNS convulsions, coma
GPE fever, restlessness, cyanosis
GI vomiting, diarrhea
Kerosene poising
Kerosene ingestion:
Risk of aspiration
GIT & Respiratory effects.
Burning sensation, nausea and diarrhea
Cough, chocking, gagging and grunting.
CXR 2-8 hrs later: Pulmonary infiltrates or
perihilar densities.
pneumatoceles, pleural effusion or
pneumothorax and bacterial superinfection
Resolution 2-7 days.
Lab Investigations
Blood Leukocytosis
X Ray changes
Pneumothorax
Pneumatocoeles
Pleural effusion
Bronchopneumonia
Coma
Organophosphorus Poisoning
Stage 2
Quiescent stage: 4-48hrs
Clinical improvement
Subtle hemodynamic changes:
Tachycardia
Iron Poisoning
Stage 3:
Circulatory collapse : 48-96 hrs
Metabolic acidosis, hypotension, low
Cardiac output.
Coagulopathy
Multiorgan system failure
Iron Poisoning
Stage 4:
Hepatic failure: 96 hrs
Increased mortality
Rarely fulminant hepatic failure
Hepatic necrosis
Liver transplant can save lives
Iron Poisoning
STAGE 5:
Bowel obstruction 2-6 wks
Due to scarring
Gastric outlet obstruction
Small intestinal obstruction
May not pass through stage 4
Treatment
Vomiting should be induced and stomach
should be washed with sodium
bicarbonate solution. Shock is corrected by
infusion of fluids parenterally. Three mL of
7.5 percent sodium bicarbonate solution
per kg of body weight are diluted with 3
times its volume of 5 percent glucose
solution and injected intravenously for
treatment of acidosis. This dose may be
repeated after an hour if acidosis is
persisting.
Iron salts are chelated with
desferrioxamine IV at 15mg/kg/hour until
the serum iron is <300 mg/dL or till 24
hours after the child has stopped passing
the characteristic vin rose colored urine.
Presence of vin rose color to urine
indicates significant poisoning.
Iron Poisoning
Management:
1. Gastric decontamination:
Forced emesis
Gastric lavage with 5% NaHCO3
No activated charcoal
2. Secure good IV
3. Get initial the 4hrs levels and TBC
4. Chelate with Deferoxamine if levels>
300mg/dL
Iron Poisoning
MANAGEMENT
Treat electrolyte imbalance
IV hydration
Hemodialysis
Diuretics