Poisoning in children
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POISONING
BY
Dr. HAMDY ABO HAGARLecturer of Pediatrics
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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
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Poison Identification
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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.
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Poison identification
3. When the nature of the substance ingested is unknown, the list of common symptoms or signs are presented in table
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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.
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Poison identification
HISTORY
EXAMINATION
MANIFESTATIONS
ANALYSIS
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Toxidromes
(Symptoms and signs of common toxic exposures)
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Toxidromes System involved
(CNS)Substance involved
Depression and coma
- Sedatives, - Narcotics, - Tranquilizers, -Tricyclic antidepressants, - Anticonvulsants, - Alcohol, - Hypoglycemic agents, - Hydrocarbons, - lead, mercury, lithium and CO.
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System involved(CNS)
Substance involved
- Convulsions - Amphetamines, - Xanthines, - Sympathomimetics, - Psychotropics, cocaine, - Ergot, - Strychnine,- organophosphates,
Toxidromes
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System involved(CNS)
Substance involved
- Hallucinations Amphetamines, psychotropics, alcohol withdrawal, antihistamines, cocaine, tricyclic antidepressants.
Toxidromes
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Toxidromes
System involved(CNS)
Substance involved
- Hyperpyrexia Atropine, salicylates
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Toxidromes
System involved(CVS)
Substance involved
- Arrhythmias - Digitalis, quinidine, tricyclic antidepressants, cocaine
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Toxidromes
System involved(CVS)
Substance involved
- Tachycardia -Amphetamines, -xanthines, sympathomimetics, - cocaine, -tricyclic antidepressants
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Toxidromes
System involved(CVS)
Substance involved
- Bradycardia -Beta blockers, cardioglycosides, -quinidine, -calcium-channel blockers.
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Toxidromes
System involved(CVS)
Substance involved
- Hypotension - Antihypertensive agents, tricyclic antidepressants, narcotics
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Toxidromes
System involved(GIT)
Substance involved
- Nausea, vomiting, and diarrhea
- Almost any toxic substance can produce these symptoms and signs.
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Toxidromes
System involved(GIT)
Substance involved
- Increased salivation
- Insecticides
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Toxidromes
System involved(GIT)
Substance involved
- Decreased salivation
- Antihistaminic, antimuscarinic agents
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Toxidromes
System involved(Respiratory )
Substance involved
- Hypoventilation - CNS-depressant agents
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Toxidromes
System involved(Respiratory )
Substance involved
- Hyperventilation -Salicylates, -cocaine, -nicotine,- CO2
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Toxidromes
System involved(Ocular)
Substance involved
- Mydriasis -Atropine, sympathomimetics, psychotropics, -cocaine
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Toxidromes
System involved(Ocular)
Substance involved
- Miosis - Narcotics,- Organophosphate insecticides, - Parasympathomimetics
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ToxidromesSystem involved
(Cutaneous)Substance involved
- Cyanosis -Nitrites, -aniline dyes
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Toxidromes
System involved(Cutaneous)
Substance involved
- Jaundice -Carbon tetrachloride, benzene, -phenothiazines
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Supportive therapy :
1. Cardiopulmonary support. The ABCs items of cardiopulmonary resuscitation are applied for poisoned child.
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Supportive therapy :
2. Fluid support. Replace the previous and ongoing fluid losses while correcting electrolyte disturbances.
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Supportive therapy :
3. Hematologic support. Correction of hemolytic anemias with packed RBCs or exchange transfusion.
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Supportive therapy :
4. CNS support. For control of seizures and prolonged care of comatose child.
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Supportive therapy :
5. Renal support. Renal function is monitored and hemodialysis is instituted as needed.
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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.
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Gastrointestinal decontamination:
Ipecac syrup Is the method of choice for gastric
emptying, where it induces emesis within 15 minutes of intake.
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Gastrointestinal decontamination:
Orogastric lavage Is as effective as ipecac and offers
the advantage of speed and the prompt administration of adsorbent and cathartic.
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Gastrointestinal decontamination: Orogastric lavage
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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.
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Gastrointestinal decontamination:
C) Cathartics: • As magnesium citrate and sorbitol.• They hasten transit of gastrointestinal
contents, thus decreasing systemic absorption of the toxin.
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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.
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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.
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Elimination enhancement:
4. Extracorporeal poison removal, such as by hemodialysis, peritoneal
dialysis and exchange transfusion.
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Antidotes
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Antidotes
The number of ingestions for which there is a specific
antidote is small.
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Antidotes
Poison Antidote dose
-Carbon monoxide
-Chlorpromazine and
metoclopromide (primpran)
Oxygen
Diphenhydramine
- 100% or hyperbaric O2
0.5 -1 mg/kg, IV or IM.
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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.
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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)
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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.
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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.
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THANK YOU