Misc

Question 1

Management of body packers:

Answer 1

Body ‘stuffer’ = hastily concealed: ie. usually stomach or orifice, prone to leak, but small doses.
—> AC within 1 hour
—> examine orifices
+

Body packer: carefully packaged, usually in large bowel, HUGE doses.
—> high-risk if package rupture: ICU or tox unit, IV access, staff briefed, continuous monitoring
—> Allow to eat and drink
—> Gentle laxatives
—> Seek and treat toxicity
—> Look for bowel obstruction
—> CTAP non con ?package number
—> Keep until expected number passed OR 3x package free stools

*CT not accurate at counting beyond 15 packets.

In emergency (symptoms in a packer, or obstruction): SURGERY IMMEDIATELY.
- Endoscopy
- Laparotomy (safer re rupture risk)

*WBI- controversial. Rarely indicated.

Question 2

‘One pill can kill’ meds (10kg child):

Answer 2

ABCD POSTNV

Amphetamines
Baclofen (sedative-hypnotic)
CCB (XR)
Carbamazepine
Chloroquine/ hydroxychloroquine
Clozapine
Dextropropoxyphene

Propranolol
Opioids
Sulfonylureas
Theophylline
TCA
NOAC
Venlafaxine

Question 3

‘One sip/mouthful can kill’ liquids (10kg child)

Answer 3

PHONC

Paraquat (weed killer)
Hydrocarbons (EUCALYPTUS, lighter fluid, kerosene, polish, motor oil, propane)
Organophosphates (insecticides)
Napthelene (mothball, toilet cake)
Camphor (Vaporub, tiger balm,
Corrosives

Question 4

Principles in paediatric poisonings:

Answer 4

Almost always benign
Assume worst case scenario re dose
Remember the pill/sip can kill agents
-ABCD POSTV
- PHONC
Don’t have to screen for paracetamol
Activated charcoal can be mixed with icecream. Other decontam methods (including NGT AC- asp death), rarely.

Consider NAI:
- <12mo (pre mobile/ dextrous)
- Unavailable agent (eg. Paraquat in city)
- Suggestion of very large dose
- Suggestion of repeated exposure

Question 5

Management of unknown ingestion in a child:

Answer 5

Most are benign.

Ensure in tox-capable facility
Observe for 12 hours

BSL on admission, and at discharge
No other screening (eg. Paracetamol, ECG) routine
Defer IV access
Obs. Telemetry not routine
Discharge during daylight hours
Parental education

Question 6

Principles in obstetric poisonings:

Answer 6

Mostly the same
Best care for baby usually good care of Mum
All decontamination methods can be used
NAC and other antidotes are fine

A few things are worse for fetus than mum:
- Carbon monoxide
- Methemglobinaemia- inducing (Prilocaine,
- Salycilates
—> lower Tx threshold

Counsel mum after recovery re potential teratogenicity

Consider breastfeeding vs interruption based on agent

Question 7

Which drugs can cause Methemglobinaemia?

Answer 7

Prilocaine, benzocaine, lignocaine, tetracaine
Anti-malarials (eg. Quinine)
Amyl nitrate/ “poppers”
SNIP
Moth balls

Question 8

Management of Methemglobinaemia:

Answer 8

Confirm: MetHb > 10%/ normal PaO2

• Remove source
• 100 FiO2
  –> Saturate any Hb available
  –> DON’T expect SpO2 to respond

If MetHb >20 with symptoms, >25% at all, >10% with cardio resp comorbidities:

• METHYLENE BLUE 1-2 mg/kg IV. Repeat after 30mins if MetHb still >20%
• Back up options:
  —> Ascorbic acid
  –> HBO
  –> Exchange transfusion