4.3 Pediatric Poisoning

Question 1

Poisoning

Answer 1

• Half of all poisoning occur under the age of 6 (most happen at home)
• Adolescent poisoning non-accidental (they were trying to poison themselves)
• Poisoning of younger children is due to curiosity, so parents need to lock away poisons.
• Parents should never teach their children that medication is candy
• Induced vomiting is no longer considered a good practice for getting rid of poison when children poison themselves due to risk of damaging tissue. There are however some circumstances where this is still used

Question 2

Tylenol Poisoning

Answer 2

• Exceptionally common

S/S
- N/V
- Sweating
- Pallor
- Hepatic toxicity is noticeable between 36 hours to 1 week (RUQ pain, confusion, coagulation disturbances)

Antidote - N-acetylcysteine (Mucomyst) - Given orally or IV

Question 3

Supplemental Iron Poisoning

Answer 3

Signs and Symptoms (Depends on Timeframe)

First 6 hours
- Vomiting, diarrhea, hematemesis, bloody stools, gastric pain

12-24 Hours
- Metabolic acidosis, bleeding, fever, shock

2-5 Days
- Hepatic Toxicity (seizure or coma)

Antidote
Chelation Therapy - Instill chelating agents through IV into patient which increases iron excretion.

Question 4

Lead Poisoning

Answer 4

• Found common in ceramic plates, candies, paint on toys, houses built prior to 1978 used lead paint, certain parental occupations, contaminated food, water or soil.
• Low socioeconomic class living in older houses is a major concern for lead poisoning
• Lead can be ingested or inhaled
• It interferes with cell function in the nervous system
• Affects metabolism of Vitamin D and Calcium
• Lead accumulates in blood and soft tissue but is housed in bones and teeth where it slowly distributes to the body
• Screenings for lead happens at 1, 2 and 3 years old.

S/S
- BLOOD LEVELS OF OVER 5 ARE CONCERNING FOR LEAD
- Decrease in IQ, cognitive deficiencies, growth delays, struggling in school (MOST COMMON)
- Unexplained fatigue, weakness, anemia

TREATMENT
- Chelation Therapy - Instill chelating agents IV that bind to iron for excretion

Question 5

Lead Poisoning Prevention

Answer 5

• Keep toxic agents out of reach of children (keep them locked up)
• Do not store anything in lead based containers that can be ingested or release lead particles into the air that can be inhaled
• Hand hygiene before meals or naps
• Wash toys/pacifiers
• Parents/Guests should remove shoes before entering house, especially if they have an occupation that is high risk of lead exposure
• Houses built before 1978 are recommended to use wet rag to wipe surfaces that may have lead particles on them
• Healthy diet (deficiencies in Iron, Calcium, Vitamin C are more susceptible to lead poisoning)
• Screenings for high risk children is important

Question 6

Management of Poisoning

Answer 6

Step 1 (IMMEDIATE)
- Assess child, ABCs, CPR if needed

Step 2 (IMPORTANT)
- Terminate exposure of poisoning (pushing pills out of way, moving cleaning solutions to somewhere child cannot reach)
- Call Poison Control and Follow the Steps

Step 3
- Identify the poison and search the environment

Step 4
- Prevent further injury and absorption. Avoid aspiration

Step 5
- Eliminate the toxin

Step 6
- Administer Antidote

Step 7
- Monitor VS, I&O’s, Cardiac Monitoring

Question 7

Poison Prevention Education

Answer 7

• Teach how to store poisons out of reach of children
• Teach children not to ingest non-food items
• Parents should always have poison control phone number
• Professional help with renovations to an old home made before 1978

Question 8

Steps

Answer 8

1 - ABC’s and CPR if needed
2 - Terminate the exposure
3 - Identify poison in question by searching the environment
4 - Prevent further injury and absorption. Place patient in recovery position to avoid aspiration if emesis or decreased level of consciousness occurs
5 - Eliminate the toxin
6 - Administer an antidote
7 - Monitor VS, I&O, and Cardiac Monitoring