Poisonings in children

8/9/2019 Poisonings in children

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PRESENTED BYPRESENTED BY

MALAR KODI. SMALAR KODI. S

M.SC (N) II YEARM.SC (N) II YEAR

DR.SYAMALA REEDY COLLEGE OFDR.SYAMALA REEDY COLLEGE OFNURSINGNURSING


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National poison information centre india

Reported 30.6% of poisoning in

children.

In that oral poisoning was 96.8%dermal exposure was 3.2%


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How poison gets into the body

Through,

Mouth (ingestion)

Lu

ngs (inhalatio

n) skin (injection)


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Example for poisons are

Pesticide

Windshield washer fluid

polish

PlantsPaint thinner

Cigarettes

Kerosene

Lamp oilToilet bowl cleaners

lead


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unintentional ingestions by toddlers

Suicide attempt by adolescents

lead poisoning in children in old

housesDaily pesticide exposure in

children living on farms


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PATTERN OF POISONINGPATTERN OF POISONING

Chemical products, mostoftenswallowed by children includehousehold cleaners (bleach, detergents)fuel (kerosene, paraffin), cosmetics,

medicines, paints and products forhousehold repairs and householdpesticides.

Bites and stings ofanimals and insects,and ingestion ofpoisonous plants andseeds also considerably accountforoutdoor poisoning in children.


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Ecology of poisoning

Interaction between the host and theenvironment (including easy access tothe poisonous substances) determinesthe magnitude ofthe problem.

Age. About 40% ofall cases ofaccidental poisoning in children arereported in the second yearof life;about 12% ofthe cases occur in the first

and 20% inthe

third year. Hyperac

tivemale children are more prone to

accidental poisoning.


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Continued.

Small accommodation

Environment:Lead poisoning iscommon in children living in areas were thereare workshops for automobile, lead storagebatteries orfor manufacture of lead typesetsfor printing presses. Rural or Urban areas:

The pattern of poisoning varies inrural and urban areas due to exposures todifferenttypes ofpotential poisons. Snakebites

are more common in those wandering in fields.Also pesticides are more common in rural setup. The poor are driven by starvation toexperimenton roots and fruits thus leading topoisoning.


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Continued..

Large families: In large families

mother is often too occupied with

household chores, is easily fatigued

and often careless in storage of

potentially poisonous household

substances.


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Classification of poisonsClassification of poisons

Based on the chiefsymptoms they

produce

Corrosives- strong acids, strong

alkalis, metallic salts.

Irritants- organic, inorganic.

Systemic- cerebral, spinal, peripheral,

CVS, asphyxiates.Miscellaneous- food poisoning etc..


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General signs and symptomsGeneral signs and symptomsGeneral signs and symptomsGeneral signs and symptoms

SymptomsSymptoms--odor, sweating, fever, delirium,convulsions, burns ofmouth, blindness,GI symptoms, abnormal movements,coma.

SignsSigns- blindness, facial twitching, dull& mask like expression, pallor,cyanosis, hypothermia, sweating,respiratory symptoms, CVS symptoms,

CNS symptoms.

SymptomsSymptoms--odor, sweating, fever, delirium,convulsions, burns ofmouth, blindness,GI symptoms, abnormal movements,coma.

SignsSigns- blindness, facial twitching, dull& mask like expression, pallor,cyanosis, hypothermia, sweating,respiratory symptoms, CVS symptoms,

CNS symptoms.


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History Taking

What poison was..

Ingested, Time since ingestion

Total amountofpoison ingested.Route ofexposure.

Progression ofsigns and symptoms sinceingestion.

Family history ofepilepsy, mental subnormality, bleeding disorder.Whetherthe patient is receiving othermedications which may interact with thepoison.


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Poisoning severity GradesPoisoning severity GradesPoisoning severity GradesPoisoning severity Grades

None(0)- no symptoms or signs/vaguesymptoms judged notto be related topoisoning.

Minor(1)- Mild, transient & spontaneouslyresolving symptoms.

Moderate(2)- pronounced or prolongedsymptoms.

Severe(3)- severe or life threatening

symptoms.


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First-Aid for Poisonings

swallowed poison:

If you find your with an open or emptycontainer of a toxic substance, your childmay have been poisoned. Stay calm and

act quickly

Get the poison away from the child.

If the substance is still in the child's mouth,make him/her spit it out or remove it withyour fingers (keep this along with any otherevidence of what the child has swallowed).


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Con

Do not make the child vomit (your child'sphysician or poison control center willinstruct you when it is necessary to makethe child vomit).

Do not follow instructions on packagingregarding poisoning as these are oftenoutdated; instead call your child's physician

or poison control center immediately forinstructions.


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Poison on the skin:

If your child spills a chemical on his/herbody, remove any contaminated clothes

and rinse the skin well with lukewarm - nothot - water. If the area shows signs ofbeing burned or irritated, continue rinsingfor at least 15 minutes, no matter how

much your child may protest. Then, call thepoison center for further instructions. Donot use ointments, butter, or grease on thearea.


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Poisoning FirstAid: DoNot

DO NOT give an unconscious victim anything bymouth.

DO NOT induce vomiting unless you are told to doso by the Poison Control Center or a doctor. A

strong poison that burns on the way down thethroat will also do damage on the way back up.

DO NOT try to neutralize the poison with lemonjuice or vinegar, or any other substance, unlessyou are told to do so by the Poison Control Centeror a doctor.

DO NOT use any "cure-all" type antidote.DO NOT wait for symptoms to develop if yoususpect that someone has been poisoned.


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Basic Management of aBasic Management of a

poisoned childpoisoned child

Antidotes are available for very feware available for very fewcommonly encountered poisons, andcommonly encountered poisons, andtreatment is usually nontreatment is usually non--specific andspecific and

symptomatic. In such cases managementsymptomatic. In such cases managementconsists of emergency first aid andconsists of emergency first aid andstabilization measures, appropriatestabilization measures, appropriatetreatment to reduce absorption, measurestreatment to reduce absorption, measuresto enhance life support followed byto enhance life support followed bypsychiatric counseling.psychiatric counseling.


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Continued

Neurological assessment is made by

calculating the Glasgow Coma Score

(GCS).


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Initial resuscitation stabilization

Includes airway- proper positioning head tilt and chinlift, suction ofsecretions from or pharynx, falling backoftongue is prevented by suitable airway tube.

Breathing- oxygen via a mask, when gag/cough reflects

is absent- ETtube inserted. ifnecessary positivepressure ventilation with ABG monitoring, respiratorystimulants for severe respiratory depression.

Circulation- properIV access, maintenance offluid &electrolyte balance, IV drugs fortreatment.


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Symptomatic & supportive

Management

Homodynamic supportHomodynamic support-- elevation ofelevation offoot end ofthe bed, oxygenfoot end ofthe bed, oxygenadministration, IVfluids, bloodadministration, IVfluids, bloodproducts.products.

Cardiac dysrrhythmiasCardiac dysrrhythmias-- correctioncorrectionofhypoxia, acidosis, hypokalemia,ofhypoxia, acidosis, hypokalemia,ECG, treatment with antiarrhythmicECG, treatment with antiarrhythmicdrugs.drugs.

ConvulsionsConvulsions-- correction ofcorrection ofhypoglycemia/hypocalcaemia/hypohypoglycemia/hypocalcaemia/hypoxia/cerebral edema and otherxia/cerebral edema and othermetabolic defects, anticonvulsantmetabolic defects, anticonvulsant

therapy.therapy.


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Continued.

Dermal decontamination.

Absorption oforgan phosphorus

and related compounds through

cutaneous route can prove to be a

fatal as oral route absorption.

Cutaneous absorption depends on

several factors such as lipidsolubility, skin condition, location,

caustic effect, physical conditions


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Continued.

Gut decontamination. This

includes

(i) gastric evac

uatio

n;(ii) adsorbent administration;

(iii) catharsis. Emesis is the

preferred me

tho

dof

emptying

thestomach in conscious children.


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Gastric evacuation (Emesis)

Vomiting can be induced bytickling the faces with a finger, featheror a leafy twig ofa tree;

administration ofcopious draughts of

warm water;gurgling with non-detergent soap; or

saline emetics in warm water. Toprevent aspiration in small children, thehead should be kept low.


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Continued..

Syrup of ipecac may be used for inducingemesis in children olderthan 6 months in asingle dose of10 ml for 6-12 months age, and15 ml for children above 1 yearofage. The

dose may be repeated in 20 minutes forthosemore than 1 yearofage.

Induction ofvomiting is contraindicated incorrosive or kerosene poisoning and in

comatose patients orthose with absent gagreflex.

GATRICLAVAGE


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CATHARSIS

Laxative and purgatives may be

given in poisoning. Commonly used

are sorbital and monnital(1-2g/kg)and megnesium orsodium

sulfate(200-300g/kg)


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PROMOTION OF EXCRETION

POISONING

PROMOTION OF EXCRETION

POISONING

FORCED DIURESIS.

HEMODIALYSIS.

PERIDONEAL DIALYSIS.


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Specific Antidotal Therapy

The antidotes may be physiological, chemicalor physical. Chemical antidotes combine withthe poison and render it innocuous.

Physiological antidotes counteractthe effectsofthe poison on the metabolism andphysiological functions ofthe body and thusprevent its harmful effects. Physical antidotespreventthe contactofthe poisonous

su

bstance wi

ththe

targe

to

rgano

r adso

rbthetoxic components, thus preventing their

toxicity.


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Common antidote used

TOXIN ANTIDOTES

1.Anticholinergics physostigmine2. Acetaminophen N-acetylcystein

3.carbon-monoxide Oxygen

4.Cyanide Sodium nitrite

5. Iron salts Deferral

6. Narcotics Naloxone7.Organophosphates Atropine

8.Isoniazid Pyridoxine.


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CONTINUED

Treatthe convulsion with diazepamand midozolam.

Renal failure maintained by

standard protocolInfection should be treated withantibiotics

Fever and pain are relieved withantipyretics and analgesics.


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Prevention of poisoning (PENSE)Prevention of poisoning (PENSE)

-Protection of the child from the

poisonous substances.

-Education of parents.

Need for parental supervision.

-Safety regulation.

-Establishment of poison control centers.


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ANY QUESTION?

?

Poisonings in children

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