CHILDHOOD POISONING

DR KARAMBELKAR

WHY CHILDREN ARE VULNERABLE ?

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IMMATURITY
LAREGE SURFACE AREA
REQUIRE MORE AIR, WATER, FOOD/Kg
HAND TO MOUTH BEHAVIOR
PLAY CLOSE TO GROUND
IMMATURE METABOLIC PATHWAYS
MAY AFFECT DEVELOPING BODY, SYSTEMS
CHRONIC MULTISTAGE DISEASE DUE TO
LONG LIFE

ROUTES OF EXPOSURE
1. TRANSPLACENTAL.DDT, HEAVY
METALS
2. WATER.Lead
3. AIR.Diesel exhaust, benzene,
Tobacco
4. FOOD.Pesticides
5. Contaminated Parental clothes.OP
6. SkinPesticides
7. Child Labor.OP, OC, cement

ROUTES OF EXPOSURE
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ACCIDENTAL INGESTION/OVERDOSE
ACCIDENTAL INHALATION
ACCIDENTAL SKIN/EYE CONTACT
INTENTIONAL INGETION/INHALATION
CHRONIC EXPOSURE
ANIMAL/HUMAN BITES
BIO TERRORISM

WHEN TO SUSPECT
1. BROUGHT WITH HISTORY OF
POISONING
2. CHARACTERISTIC CLINICAL PICTURE
3. UNEXPLAINED CLINICAL SIGNS
4. ACUTE ONSET LIFE THREATENING
SCENARIO
5. UNSTABLE VITAL SIGNS

EXPOSURE HISTORY
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MUST BE RELIABLE
PRODUCT NAME/ INGREDIENT(S)
CONCENTRATION
QUANTITY/DOSE, ROUTE,TIMING
SINGLE/RECURRENT EXPOSURE
ACCESIBLE ITEMS IN HOUSE/GARAGE
ANY ADULT TAKING Rx
? VOMITING/DECONTAMINATION DONE

EXPOSURE HISTORY
IDENTIFY EXACT SUBSTANCE
DOSE/QUANTITY
TIME LAPSED
ASK PARENTS TO BRING THE
BOTTLES, CANS,
TABLETS/MEDICATIONS
ASK THEM TO BRING DEAD
SCORPION/SNAKE

CLINICAL SIGNS
HYPOTHERMIABARBITURATES
HYPERTHERMIAATROPINE/INH/SALICYLATE
BRADYPNEA
NARCOTICS/SEDATIVES/ALCOHOL
TACHYPNEACO,SALICYLATE,KEROSENE
BRADYCARDIAOPP, MEDICINES
TACHYCARDIABeta AGONISTS,ATROPINE
HYPOTENSIONCO, OPIOIDS, MEDICINES
HYPERTENSIONANTICHOLINERGICS

CLINICAL SIGNS
ODORS
ACETONE
ALCOHOL
BITTER ALMONDCYANIDE
GARLICOPP
KEROSENE
HYDROCARBON

CLINICAL SIGNS
CYANOSIS.METHEMOGLOBINEMIA
CYANOSIS NOT RESPONDING TO O2
NITROBENZENE
FLUSHED SKINALCOHOL, ATROPINE,
CO
DIAPHORESISSYMPATHOMIMETICS
DRY SKIN/MUCUS MmbATROPINE,
DHATURA
SALIVATION/LACHRYMATION
OPP,CARBAMATE

CLINICAL SIGNS CNS

Depression/Instability (Acute, Delayed,
Transient)
Ataxia Alcohol, Hydrocarbon
DeliriumAnticholinergics
MiosisBarbiturates.opioids,OP
MydriasisAtropine, Methanol
NystagmusAED, MAOI
Paralysis.Botulism, Shellfish
SeizuresAlcohol, Camphor, CO, OP

Toxidromes
Atropine,Belladona Mad as hatter,
red as beet, blind as bat, hot as hare,
dry as bone
OPP Salivation,
Lachrymation,Urination, Defecation,
Gastric cramping, Emesis SLUDGE
Diarrhea, Urination, Miosis,
Bronchospasm, Emesis,

Lab Investigations

HMG
Urine.for crystals
Stool
SE
CXR
ABG
Toxicology Screen

Management
Airway, Breathing, Circulation
Skin Decontamination
Gastric DecontaminationCheck
Gag, R/o Hydrocarbon/corrosives,
Protect airway
Activated CharcoalCarbamazepine,
Barbiturates ( should be within 1 Hr)
Ipecac.NOT RECOMMENDED

Specific Antidotes
AcetaaminophenN-Acetylcysteine
MethanolEthanol
OPPAtropine, Pralidoxime
AnticholinergicsPhysostigmine
BenzodizepineFlumazenil
Beta-BlockersGlucagon
OpiumNaloxone
Digoxin.Digoxin specific Antibodies
IronDesferoxamine

Management
Forced Alkaline Diuresis3mEq/kg
NaHCO3 in 4 hrs or 1-2 mEq/Kg IV
over 2 Hrs
Active Removal by Hemodialysis or
Hemofiltration

Prevention
Baby Safe Home
Psychotherapy in cases of attempted
suicide, drug abuse, substance
abuse, alcoholism