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Poisoning

Poisoning is defined as exposure to an agent that can cause organ dysfunction, leading to injury or death. Children less than 6 years of age account for 60.8% of poisonings.

Clinical evaluation of poisoning

The type of toxin involved should be determined. The time of the exposure and how much time has elapsed should be determined.

The dose of the toxin should be assumed to be the maximum amount consistent with the circumstances of the poisoning.

Munchausen syndrome by proxy

Chemical child abuse should be suspected when childhood poisonings are associated with an insidious and/or inexplicable presentation (eg, recurrent acidosis, polymicrobial sepsis, recurrent malabsorption syndrome, factitious hypoglycemia, failure to thrive).

The syndrome is referred to as "Munchausen syndrome by proxy" when the abuse is perpetrated by a caretaker. Agents may include aspirin, codeine, ethylene glycol, fecal material, insulin, ipecac, laxatives, phenothiazines, table salt, and vitamin A.

Physical examination

The first priority in a severely poisoned child is to maintain an airway, ventilation, and circulation.

The vital signs, breath odors, skin, gastrointestinal, cardiovascular, respiratory, and neurologic systems.

Skin examination

Cyanosis suggests hypoxia secondary to aspiration (eg, hydrocarbon) or asphyxia.

Cardiovascular effects

Sympathetic stimulation can cause hypertension with tachycardia.

Hypotension is caused by beta adrenergic blockade, calcium channel blockade, sympatholytic agents, cellular toxins, psychopharmaceutical agents, disulfiram_ethanol, and shock associated with iron or arsenic.

Respiratory effects

Tachypnea and hyperpnea may result from salicylate poisoning. Nervous system stimulants.

Toxidromes

Diagnostic trials

For a few poisons, a "diagnostic trial" of an antidote can implicate an agent as the cause of a poisoning.

Management

Poison centers can help with the diagnosis and management of poisonings, and assist in locating exotic antidotes.

Initial management of poisoning involves maintaining an airway, providing ventilatory support, securing vascular access, and initiating resuscitation.

Decontamination

Skin, mucous membrane, or eye exposures should be washed with a stream of lukewarm water for 15 to 20 minutes. Soap is used to decontaminate skin exposures.

Emesis is most effective when less than 1 hour has elapsed since the ingestion; it can remove.

Antidotes

Specific toxins

Acetaminophen (APAP)

Single overdoses of greater than 150 mg/kg can cause liver failure. Nausea and abdominal pain are common. The patient may vomit repeatedly, be mildly lethargic, or remain asymptomatic. At 24 to 36 hours after the ingestion, abdominal tenderness and rising serum transaminase levels signify onset of

Alcohols

Alcohols include ethanol, ethylene glycol, methanol, and isopropyl alcohol.

Antifreeze contains ethylene glycol, Sterno and windshield wiper fluid contain methanol, jewelry cleaners and rubbing alcohol contain isopropanol.

All of the alcohols cause inebriation, loss of motor control and coma. Ethylene glycol may cause

Caustics

Drain cleaners contain sodium hydroxide or sulfuric acid; toilet cleaners may contain hydrochloric or sulfuric acids.

Laundry or dishwasher detergents may contain sodium metasilicate or sodium triphosphate.

Signs of caustic ingestion include lip or tongue swelling; burning pain; dysphagia; drooling; and whitish

Foreign body ingestion

Aspirated objects will cause symptoms of choking, gasping, coughing, cyanosis, wheezing, fever, and poor air entry. While chest radiography can confirm the diagnosis, a negative film does not rule out aspiration. A foreign body requires immediate removal by bronchoscopy.

Ingestion of disc batteries requires removal when lodged in the esophagus; those in the stomach or beyond should be followed with repeated abdominal films every 2 to 3 days to ensure passage. Disc batteries that have remained in one position for more than 7 days may require surgical removal. Coins or 

Hydrocarbons

Aliphatic hydrocarbons include kerosene, mineral oil, gasoline, and petrolatum. Kerosene and gasoline are capable of causing an aspiration pneumonia and CNS depression. Petrolatum, mineral oil and motor oil do not carry significant risk of injury. Aliphatic hydrocarbons in small doses are not

Aromatic hydrocarbons, such as xylene or toluene, are toxic. Aromatic hydrocarbon ingestions necessitate lavage because of their potent toxicities.

Aspiration pneumonia is suggested by gasping, choking, coughing, chest pain, dyspnea, cyanosis,

Iron

Iron is present in many children's multivitamins, although the worst cases of iron poisoning usually involve prenatal vitamins, which contain 60 mg of elemental iron per tablet. In overdose, iron is a metabolic poison and is corrosive to gastric mucosa, resulting in shock.

Ferrous sulfate is 20% elemental iron, ferrous fumarate 33%, and ferrous gluconate 11%. Little toxicity is seen at a dose of elemental iron less than 20 mg/kg. Mild symptoms of poisoning are seen at doses of.

Salicylates

Aspirin overdoses greater than 150 mg/kg are toxic. Salicylates are locally corrosive, and tablets can form bezoars near the gastric outlet. Salicylates stimulate the central respiratory center, so that the