Poisoning in children
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Transcript of Poisoning in children
POISONING
BY
Dr. HAMDY ABO HAGARLecturer of Pediatrics
Ingestion of toxic products by children is a common occurrence.
Children under 5 years of age account for 80% of recorded cases of poison ingestion.
INCIDENCE
Poison Identification
Poison identification
1. The initial history should include the identification of the product ingested (containers or bottles should be brought).
2. Physical examination will often reveal supporting evidence for a particular ingestion.
Poison identification
3. When the nature of the substance ingested is unknown, the list of common symptoms or signs are presented in table
Poison identification
4. The specific substance causing a poisoning should be confirmed by qualitative analysis performed on blood or urine.
Gastric fluid analysis will be of value if done within 2-3 hours of ingestion.
Poison identification
HISTORY
EXAMINATION
MANIFESTATIONS
ANALYSIS
Toxidromes
(Symptoms and signs of common toxic exposures)
Toxidromes System involved
(CNS)Substance involved
Depression and coma
- Sedatives, - Narcotics, - Tranquilizers, -Tricyclic antidepressants, - Anticonvulsants, - Alcohol, - Hypoglycemic agents, - Hydrocarbons, - lead, mercury, lithium and CO.
System involved(CNS)
Substance involved
- Convulsions - Amphetamines, - Xanthines, - Sympathomimetics, - Psychotropics, cocaine, - Ergot, - Strychnine,- organophosphates,
Toxidromes
System involved(CNS)
Substance involved
- Hallucinations Amphetamines, psychotropics, alcohol withdrawal, antihistamines, cocaine, tricyclic antidepressants.
Toxidromes
Toxidromes
System involved(CNS)
Substance involved
- Hyperpyrexia Atropine, salicylates
Toxidromes
System involved(CVS)
Substance involved
- Arrhythmias - Digitalis, quinidine, tricyclic antidepressants, cocaine
Toxidromes
System involved(CVS)
Substance involved
- Tachycardia -Amphetamines, -xanthines, sympathomimetics, - cocaine, -tricyclic antidepressants
Toxidromes
System involved(CVS)
Substance involved
- Bradycardia -Beta blockers, cardioglycosides, -quinidine, -calcium-channel blockers.
Toxidromes
System involved(CVS)
Substance involved
- Hypotension - Antihypertensive agents, tricyclic antidepressants, narcotics
Toxidromes
System involved(GIT)
Substance involved
- Nausea, vomiting, and diarrhea
- Almost any toxic substance can produce these symptoms and signs.
Toxidromes
System involved(GIT)
Substance involved
- Increased salivation
- Insecticides
Toxidromes
System involved(GIT)
Substance involved
- Decreased salivation
- Antihistaminic, antimuscarinic agents
Toxidromes
System involved(Respiratory )
Substance involved
- Hypoventilation - CNS-depressant agents
Toxidromes
System involved(Respiratory )
Substance involved
- Hyperventilation -Salicylates, -cocaine, -nicotine,- CO2
Toxidromes
System involved(Ocular)
Substance involved
- Mydriasis -Atropine, sympathomimetics, psychotropics, -cocaine
Toxidromes
System involved(Ocular)
Substance involved
- Miosis - Narcotics,- Organophosphate insecticides, - Parasympathomimetics
ToxidromesSystem involved
(Cutaneous)Substance involved
- Cyanosis -Nitrites, -aniline dyes
Toxidromes
System involved(Cutaneous)
Substance involved
- Jaundice -Carbon tetrachloride, benzene, -phenothiazines
Supportive therapy :
1. Cardiopulmonary support. The ABCs items of cardiopulmonary resuscitation are applied for poisoned child.
Supportive therapy :
2. Fluid support. Replace the previous and ongoing fluid losses while correcting electrolyte disturbances.
Supportive therapy :
3. Hematologic support. Correction of hemolytic anemias with packed RBCs or exchange transfusion.
Supportive therapy :
4. CNS support. For control of seizures and prolonged care of comatose child.
Supportive therapy :
5. Renal support. Renal function is monitored and hemodialysis is instituted as needed.
Gastrointestinal decontamination:
A) Gastric evacuation: It is the cornerstone of intervention
after a toxic ingestion. Its efficacy falls when it is instituted more than one hour after an ingestion.
Gastrointestinal decontamination:
Ipecac syrup Is the method of choice for gastric
emptying, where it induces emesis within 15 minutes of intake.
Gastrointestinal decontamination:
Orogastric lavage Is as effective as ipecac and offers
the advantage of speed and the prompt administration of adsorbent and cathartic.
Gastrointestinal decontamination: Orogastric lavage
Gastrointestinal decontamination:
B) Adsorbents: Activated charcoal forms a stable
complex with the toxin, thus preventing its absorption.
It is not given before ipecac and is not effective against metals, alcohols, hydrocarbons, or caustics.
It is given in a dose of 1gm/kg in water orally.
Gastrointestinal decontamination:
C) Cathartics: • As magnesium citrate and sorbitol.• They hasten transit of gastrointestinal
contents, thus decreasing systemic absorption of the toxin.
Elimination enhancement:
1. Fluid and osmotic diuresis by intake of hypertonic fluid.
2. Diuretics, such as frusemide (2 mg/kg/dose) are
used to increase urine output.
Elimination enhancement:
3. Ionized diuresis; excretion of acidic compounds, such as
salicylates and barbiturates, is enhanced by alkalinization of urine which is accomplished by IV sodium bicarbonate.
Elimination enhancement:
4. Extracorporeal poison removal, such as by hemodialysis, peritoneal
dialysis and exchange transfusion.
Antidotes
Antidotes
The number of ingestions for which there is a specific
antidote is small.
Antidotes
Poison Antidote dose
-Carbon monoxide
-Chlorpromazine and
metoclopromide (primpran)
Oxygen
Diphenhydramine
- 100% or hyperbaric O2
0.5 -1 mg/kg, IV or IM.
Antidotes
Poison Antidote dose
-Cyanide
-Organic phosphorous
Na nitrite, Na thiosulphate Pralidoxime
Atropine
- depends on hemoglobin level. 20-40 mg/kg, IV over 15-30 min 0.1 mg/kg, IV every 10-30 min until pupillary dilatation.
Antidotes
Poison Antidote dose
- Opiates, narcotics
- Iron
Naloxone (Narcan) Deferoxamine
- 0.1 mg/kg, IV, may be repeated twice. 10–15 mg/kg/hr, (IV infusion)
Antidotes
Poison Antidote dose
-Isoniazide
-Methemoglobinemia -Lead
Pyridoxine (B6)
Methyline blue EDTA
5 gm, IV 1-2 mg/kg, IV over 10 min 250 mg/M2/dose, IM, every 4 hrs.
How can I protect my child?
The most important and practical measure is to ensure toxic substances are completely out of reach in the first place.
Make a thorough check of your house and garden, removing any harmful products and placing them in a securely locked cabinet.
THANK YOU