Exam 3: the end is near Flashcards
if a child presents with an altered level of consciousness, metabolic disturbances, neurologic dysfunction, cardiac/pulmonary distress: ___
it is important to include toxic exposures as part of differential
supportive care in peds tox includes:
-begins with airway stabilization
-early antidote admin (if indicated)
what lab values do we want to initially get in children who present with toxicities?
-alcohol ingestion –> serum osmolality
-BBs or CCBs –> electrocardiogram
-always serum concentrations of acetaminophen
Gastric decontamination in peds tox: AC
-activated charcoal (consider use within 1 hr in pts with a potentially toxic ingestion)
–> dose: 0.5 - 1 g/kg
-multiple dose activated charcoal: use to prevent prolonged absorption or enterohepatic recirculation
–> dose: LD of 1 g/kg followed by 0.5 g/kg every. 4-6 hrs for up to 24 hrs
Gastric decontamination in peds tox: whole bowel irrigation
-performed using polyethylene glycol AND electrolyte solution
–> consider in pts who have ingested: sustained- release, enteric coated, iron or other metals
(can be given orally but admin via NG tube is easier in kids)
–> dose: 0/5 L/hr (small kids) up to 1.2-2 L/hr in older kids and adults for 4-6 hrs
**do NOT use miralax
Acetaminophen in ped tox
toxic ingestion: > 200 mg/kg (oral) or >. 60 mg/kg (IV) in kids
-GI decontam: AC within 1 hr
-Antidote: NAC (use IV & to prevent hyponatremia in children, product should be diluted to a concentration of 40 mg/dL)
Ethylene Glycol in ped tox
-engine coolant - has a sweet taste so kids and pets love it
-give IV pyridoxine 100 mg/day + thiamine 100mg/day until ethylene glycol metabolites are eliminated
Antidote: ethanol or fomepizole
Methanol in peds tox
ex: solvents, antifreeze, fuels, windshield washer fluid
-formaldehyde and formic acid cause lead to metabolic acidosis and blindness
-give folic acid 1 mg/kg (max 50 mg) every 4-6 hours for 24 hrs
Antidote: ethanol or fomepizole
Ethylene Glycol + Methanol Antidotes: ethanol (10%)
- can be oral or IV
LD: 8 mL/kg over 1 hr
Infusion: 0.8 mL/kg/hr
–> want serum concentrations of 100-150
Disadvantages: - requires central venous catheter
-central nervous system depression
-respiratory depression
-therapeutic drug monitoring
Ethylene Glycol + Methanol Antidotes: Fomepizole
1st line therapy!!
-load: 15 mg/kg , then 10 mg/kg q 12 h x 4 doses, 15 mg/kg q 12 h until serum concentrations are < 25
Advantages: no alternation in consciousness, no effect on blood glucose or electrolytes, no need for central venous access, no need for intensive care unit monitoring
what to do with a foreign body ingestion
-manual removal if impaction suspected
-battery may become lodged in the esophagus + result in serious life threatening complications
Signs & symptoms: vomiting, diarrhea, abdominal pain, fever, refusal to eat or drink, dysphagia
cough and cold preparations in peds tox
-avoid them in 6 years and younger, most cases lead to death
-GI decontamination: AC
-symptomatic management: htn (labetalol, nicardipine), arrhythmias (amiodarone) and seizures (benzos)
Strategies for poison prevention
-child proof caps
-child proof containers
-storage location
-environmental precautions
-taking appropriate doses
**disposal of unused, expired drugs
-never mix household products (ammonia and bleach = toxic fumes)
valuable information to collect when faced with a potential poisoning
-age and weight
-health history
-time of exposure
-route of exposure
-present symptoms
-exact name of product
-estimate how much may have been ingested
-strength of product
-formulation of product
General tx approach of poisoned pt
1- assess the pt: level of exposure, amount, symptoms
2- self tx (at home)?
3- referral to hospital: if its moderate to severe exposure or intentional ingestions
ABCDEs of management of a poisoned pt
-airway
-breathing
-circulation
-dextrose/decontamination
-EKG/elimination
Activated charcoal in a poisoned pt
-absorbant: 1 g/kg
-time window: 1 hr
-substances that will NOT bind: ionized metals, alcohols, gasoline
ADrs: vomiting, black tarry stools; want pts to have a protected airway
whole bowel Irrigation in poisoned pts
-polythylene glycol + electrolytes (1-2 L/hr PO/NG until rectal effluent is clear
-goal is to minimize time in GI tract for absorption
-beneficial for XR products and body packets
Orogastric lavage in poisoned pts
“stomach pumping”
-potential to produce serious toxicity
-use when no antidote exists
-time window gives reason to believe agent may still be in stomach
Hemodialysis in poisoned pts
-use when other elimination strategies are not effective/contraindicated
-potential to produce serious toxicity
-agent able to be removed through filtration
Anticholinergic toxidrome
-delirious
- high HR, pupils, BP, RR, temp
-signs: blindness, confused, hot, dry membranes, urinary retention, redness/flushing, tachycardia, no bowel sounds + hypertensive
Antidote: physostigmine (unpopular tho)
sedative- hypnotic toxidrome
-diazepam/ ethanol
-can see dec HR, BP, RR, hyperflexia
S&S: unresponsive but has response to painful stimuli
Adrenergic/Sympathomimetic toxidrome
-methamphetamine/ cocaine
-all vital signs inc, tremors
-S&S: agitation, SWEATY and bowel sounds present
Opioid toxidrome
-heroin/morphine
-decrease in all vitals, hyperflexia
S&S: unresponsive, unresponsive to painful stimuli, low HR + RR, see pinpoint pupils, bowel sounds are absent