24: Pediatric toxicity

Question 1

<1mth old is

Answer 1

neonate

Question 2

1-12mths old is

Answer 2

infant

Question 3

when is early childhood

Answer 3

1-5yrs

Question 4

when is late childhood

Answer 4

5-12yrs

Question 5

peak pediatric poisonings happen between ages

Answer 5

1-3yrs

Question 6

describe the characteristics of poisonings in 0-5yrs old

Answer 6

Exploratory ingestions (unsupervised) most common
Poisonings may be due to parental medication errors- consider abuse/ neglect

Question 7

describe the characteristics of poisonings in 6-12yrs old

Answer 7

Accidental OD- rarely intentional
Peak for unintentional exposures (mobility, exploring) but also lowest fatality rate

Question 8

which age group has the lowest fatality rate for peds poisonings
1. 0-5yrs
2. 6-12yrs
3. 12-19yrs
4. none of the above

Answer 8

2

Question 9

describe the characteristics of poisonings for 13-19yrs old

Answer 9

Mimics adult poisoning circumstances
Common reasons may be due to suicidal self poisoning and substance use/ abuse

Question 10

the BBB is ____ permeable in neonates and young children

Answer 10

more

Question 11

describe gastric emptying time and pH from neonate to infant to adolescent

Answer 11

gastric emptying: neonate irregular, infant high, adolescent high
pH: neonate basic, infant less basic, adolescents normal

Question 12

describe oral, IM, percutaneous, and rectal absorption in neonates

Answer 12

oral erratic or decreased
IM variable
percutaneous increased
rectal v efficient

Question 13

describe oral, IM, percutaneous, and rectal absorption in infants

Answer 13

all increased

Question 14

describe oral, IM, percutaneous, and rectal absorption in adolescents

Answer 14

oral and percutaneous near adult
IM and rectal adult pattern

Question 15

serum albumin and total protein is lower at birth until ________

Answer 15

year 1

Question 16

there is a shift from ______ to _______ cellular water within 1yr

Answer 16

extracellular to intracellular

Question 17

at birth, there is less metabolism except in __________ pathway

Answer 17

sulphation

Question 18

what does it mean that an infant’s metabolism may be inducible

Answer 18

(ex- drugs admin to mom can induce neonatal enzymes)

Question 19

how does chloramphenicol cause grey baby syndrome

Answer 19

Inadequate conjugation of chloramphenicol with glucuronic acid due to ↓ activity of glucuronyl transferase in newborn liver
↓ renal elimination of unconjugated chloramphenicol

Question 20

sx of gray baby sx

Answer 20

abdominal distension, vomiting, metabolic acidosis, progressive pallid cyanosis, irregular respirations, hypothermia, hypotension, vasomotor collapse

Question 21

3 major differences in peds excretion

Answer 21

↓ sig renal function in infants/ children (1-2yrs)
↓ blood flow, GFR, tubular secretion and reabsorption
↓ CL and drug excretion

Question 22

5 drugs with immediate toxicity

Answer 22

benzocaine
camphor
methylsalycylate
opioids
TCA

Question 23

5 drugs with delayed toxicity

Answer 23

atropine
antihistamine
MAOi
SU
SR drugs like CCBs and BB

Question 24

naphthalene activity in water and dextrose

Answer 24

sinks in water
floats in dex

Question 25

camphor activity in water and dextrose

Answer 25

floats in both

Question 26

paradichlorobenzene activity in water and dextrose

Answer 26

sinks in both

Question 27

naphthalene causes toxicity by

Answer 27

being metabolized to alpha naphthol = delayed oxidative hemolysis/ stress in children with G6D deficiency

Question 28

camphor causes toxicity by

Answer 28

being a neurotoxin that triggers seizures (usually before ER presentation) and crosses BBB

Question 29

paradichlorobenzene toxicity description

Answer 29

generally nontoxic, may see issues with massive chronic OD

Question 30

mild iron toxicity is considered

Answer 30

10-20mg/kg elemental iron

Question 31

severe iron toxicity is considered

Answer 31

>60mg/kg

Question 32

what is the vin rose urine test?

Answer 32

to check for iron concentration/ toxicity when the urine is clear, there is no more iron

Question 33

what is the antidote in iron toxicity

Answer 33

deferoxamine

Question 34

describe stage 1 of iron toxicity

Answer 34

GI irritation mostly with N/V, abdominal pain, diarrhea within 30min -6hrs

Question 35

describe stage 2 of iron toxicity

Answer 35

latent stage where there are reduced GI sx and happens in 6-24hrs

Question 36

describe stage 3 iron toxicity

Answer 36

shock and metabolic acidosis, lactic acidosis, and dehydration in 6-72hrs

Question 37

describe stage 4 iron toxicitiy

Answer 37

hepatotoxicity/ necrosis = hepatic failure at 12-96hrs

Question 38

describe stage 5 iron toxicity

Answer 38

bowel obstruction from scarring after GI mucosa heals in 2-8wks

Question 39

what is brodifacoum

Answer 39

superwarfarin- used as rodent poison

Question 40

how does brodifacoum work?

Answer 40

100x more potent than warfarin in blocking production of vit K dependent clotting factors (II, VII, IX, X), Inhibits vit K2,3-epoxide reductase

Question 41

what is the tx for brodifacoum poisoning

Answer 41

vit K in those >1yrs

Question 42

when might brodifcaoum poisoning be intentional

Answer 42

Sometimes taken with other substances of abuse (Ex- cocaine) to potentiate the effects of the drug

Question 43

hydrocarbons cause _______________ toxicity

Answer 43

multiorgan system toxicity

Question 44

what is the most common system affected by hydrocarbons

Answer 44

pulmonary- aspiration pneumonia

Question 45

describe the 5Vs of hydrocarbon aspiration

Answer 45

Viscosity: ↓ viscosity = ↑ risk asp Volume: ↑ vol = ↑ risk Volatility: ↑ volatility = ↑ risk Vomiting: ↑ = ↑ risk Van der waals forces: ↓ VDWs (surface tension) = ↑ break up into little particles = ↑ risk aspiration

Question 46

the 3 toxic alcohols are ___________ and the toxicity is due to its ____________

Answer 46

methanol, ethanol, ethylene glycol metabolism

Question 47

give 3 reasons why children might be at higher risk of med errors

Answer 47

Someone other than pt administering med Young children can’t warn prescriber about allergies/ other issues Can’t inform well when they are experiencing AE Med ordering and admin freq req dose calculations Inexperienced practitioners are uncomfortable with peds dosing/ related calculations

Question 48

med errors may be in the form of

Answer 48

Dosing errors (double dosing, incorrect dosing typically due to wrong weight or age based dosing conversions) Incorrect volume unit used Decimal errors Timing errors Formulation errors (providing wrong formulation of drug due to availability of several different formulations), compounding errors

Question 49

the ISMP describes 4 types of drug errors coming from drug shortages

Answer 49

Provision of alt med that is not drug of choice can lead to inadequate tx (35%) Error with alt drug or form/ strength of sub med (27%) Omission of vital med leading to nontx of pt (27%) Error when hospital pharm attempted to compound a product/ drug strength no longer available (6%)

Question 50

many peds prescriptions 1. are considered hazardous to development 2. are considered off label 3. require compounding 4. experience dosing and formulation errors 5. all of the aboev 6. 2, 3, 4

Answer 50

6

Question 51

give 3 signs that an exposure was nontoxic

Answer 51

Product/ ingredients identified with certainty No signal words like caution, warning, danger Unintentional exposure with no evidence of suicidality, abuse, neglect Exposure to single product only Reliable assessment of dose and route of exposure Completely asymptomatic pt FU care must be available + reliable adult to monitor