24: Pediatric toxicity Flashcards
<1mth old is
neonate
1-12mths old is
infant
when is early childhood
1-5yrs
when is late childhood
5-12yrs
peak pediatric poisonings happen between ages
1-3yrs
describe the characteristics of poisonings in 0-5yrs old
Exploratory ingestions (unsupervised) most common
Poisonings may be due to parental medication errors- consider abuse/ neglect
describe the characteristics of poisonings in 6-12yrs old
Accidental OD- rarely intentional
Peak for unintentional exposures (mobility, exploring) but also lowest fatality rate
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
2
describe the characteristics of poisonings for 13-19yrs old
Mimics adult poisoning circumstances
Common reasons may be due to suicidal self poisoning and substance use/ abuse
the BBB is ____ permeable in neonates and young children
more
describe gastric emptying time and pH from neonate to infant to adolescent
gastric emptying: neonate irregular, infant high, adolescent high
pH: neonate basic, infant less basic, adolescents normal
describe oral, IM, percutaneous, and rectal absorption in neonates
oral erratic or decreased
IM variable
percutaneous increased
rectal v efficient
describe oral, IM, percutaneous, and rectal absorption in infants
all increased
describe oral, IM, percutaneous, and rectal absorption in adolescents
oral and percutaneous near adult
IM and rectal adult pattern
serum albumin and total protein is lower at birth until ________
year 1
there is a shift from ______ to _______ cellular water within 1yr
extracellular to intracellular
at birth, there is less metabolism except in __________ pathway
sulphation
what does it mean that an infant’s metabolism may be inducible
(ex- drugs admin to mom can induce neonatal enzymes)
how does chloramphenicol cause grey baby syndrome
Inadequate conjugation of chloramphenicol with glucuronic acid due to ↓ activity of glucuronyl transferase in newborn liver
↓ renal elimination of unconjugated chloramphenicol
sx of gray baby sx
abdominal distension, vomiting, metabolic acidosis, progressive pallid cyanosis, irregular respirations, hypothermia, hypotension, vasomotor collapse
3 major differences in peds excretion
↓ sig renal function in infants/ children (1-2yrs)
↓ blood flow, GFR, tubular secretion and reabsorption
↓ CL and drug excretion
5 drugs with immediate toxicity
benzocaine
camphor
methylsalycylate
opioids
TCA
5 drugs with delayed toxicity
atropine
antihistamine
MAOi
SU
SR drugs like CCBs and BB
naphthalene activity in water and dextrose
sinks in water
floats in dex
camphor activity in water and dextrose
floats in both
paradichlorobenzene activity in water and dextrose
sinks in both
naphthalene causes toxicity by
being metabolized to alpha naphthol = delayed oxidative hemolysis/ stress in children with G6D deficiency
camphor causes toxicity by
being a neurotoxin that triggers seizures (usually before ER presentation) and crosses BBB
paradichlorobenzene toxicity description
generally nontoxic, may see issues with massive chronic OD
mild iron toxicity is considered
10-20mg/kg elemental iron
severe iron toxicity is considered
> 60mg/kg
what is the vin rose urine test?
to check for iron concentration/ toxicity
when the urine is clear, there is no more iron
what is the antidote in iron toxicity
deferoxamine
describe stage 1 of iron toxicity
GI irritation mostly with N/V, abdominal pain, diarrhea
within 30min -6hrs
describe stage 2 of iron toxicity
latent stage where there are reduced GI sx and happens in 6-24hrs
describe stage 3 iron toxicity
shock and metabolic acidosis, lactic acidosis, and dehydration in 6-72hrs
describe stage 4 iron toxicitiy
hepatotoxicity/ necrosis = hepatic failure at 12-96hrs
describe stage 5 iron toxicity
bowel obstruction from scarring after GI mucosa heals in 2-8wks
what is brodifacoum
superwarfarin- used as rodent poison
how does brodifacoum work?
100x more potent than warfarin in blocking production of vit K dependent clotting factors (II, VII, IX, X), Inhibits vit K2,3-epoxide reductase
what is the tx for brodifacoum poisoning
vit K in those >1yrs
when might brodifcaoum poisoning be intentional
Sometimes taken with other substances of abuse (Ex- cocaine) to potentiate the effects of the drug
hydrocarbons cause _______________ toxicity
multiorgan system toxicity
what is the most common system affected by hydrocarbons
pulmonary- aspiration pneumonia
describe the 5Vs of hydrocarbon aspiration
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
the 3 toxic alcohols are ___________ and the toxicity is due to its ____________
methanol, ethanol, ethylene glycol
metabolism
give 3 reasons why children might be at higher risk of med errors
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
med errors may be in the form of
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
the ISMP describes 4 types of drug errors coming from drug shortages
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%)
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
6
give 3 signs that an exposure was nontoxic
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
