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