Paeds tox

Question 1

What is the toxic dose for Olanzapine in paeds?

Answer 1

> 0.5mg/kg

Usually causes sedation, agitation and tachycardia
Associated risk of aspiration, often just need monitoring

Question 1

What are the parameters for Iron overdose?

Answer 1

<40mg/kg- usually benign
40-60mg/kg- Minimal symptoms, usually GI related
60-120mg- Severe systemic toxicity
> 120mg/kg- Lethal

Question 2

What are the clinical effects of iron overdose?

Answer 2

Early
- Initial direct corrosive effects on the GIT, haematemesis, hematochezia, diarrhoea, vomiting, abdo pain
- Can have significant GI losses
- Usually within 2-6hrs then resolves

Middle
- Can have asymptomatic period between GI resolution and systemic features, onset 6-24hrs
- Disruption of cellular metabolism
- Lactic HAGMA
- Acute renal failure
- Acute liver failure
- Shock

Late
- Cardiovascular collapse

Chronic
- Significant GI fibrosis leading to strictures
- May get recurrent SBO, nutritional issues and may need resection (short gut syndrome)

Question 3

What are the treatment options for Iron OD?

Answer 3

• Activated charcoal doesn’t help
• Consider whole bowel irrigation if >60mg/kg ingested
• Endoscopic removal in >120mg/kg
• Desferrioxamine is the antidote
• Supportive care
• AXR plus asymptomatic at 6hrs can consider discharging patient

Question 4

What are examples of medicines and non-medicines that can be lethal at low doses to children?

Answer 4

Question 5

How are calcium channel blocker overdoses treated in children?

Answer 5