Pediatric Toxicity Flashcards
When must you include toxic exposure as part of differential?
Presenting with:
- Altered consciousness
- Metabolic disturbances
- Neurologic dysfunction
- Cardiac/pulmonary distress
Which guidelines should you follow for supportive care in pediatric toxicity?
Pediatric Advanced Life Support (PALS)
What should be assessed in suspected poisoning?
Serum chemistries and acid-base status
What lab is useful for alcohol ingestion?
Serum osmolality
What labs are useful for beta blockers or CCBs?
ECG
What is the main serum level to check with unknown ingestion?
Serum acetaminophen - easy to do and asymptomatic
T/F: Gastric decontamination has a lot of good evidence supporting its use
FALSE: Little data and even discouraged in some guidelines
Which gastric decontamination strategies are NOT recommended
- Syrup of ipecac
- Gastric lavage
What dose of activated charcoal should be used?
0.5-1 g/kg
What are benefits of multiple dose activated charcoal?
- Prevent prolonged absorption or enterohepatic recycling
- Dialyzes certain drugs (can be good or bad)
Loading dose of 1g/kg followed by 0.5g/kg every 4-6h up to 24h
When should whole bowel irrigation be considered?
- Sustained release
- Enteric coated
- Iron (or other metals)
What should NOT be used for whole bowel irrigation?
MiraLAX (no electrolytes)
What dose of PEG+electrolyte should be given for WBI?
0.5 L/hr (small children) up to 1.2-2 L/hr
What is acetaminophen toxicity in children?
PO > 200mg/kg
IV >60mg/kg
How should acetaminophen toxicity be treated?
AC within 1 hour
NAC IV diluted to 40 mg/mL
How should ethylene glycol toxicity be treated?
Pyridoxine 100 mg/day + thiamine 100 mg/day
Antidote: ethanol or fomepizole
GI decontamination NOT recommended
How should methanol toxicity be treated?
Folic acid 1 mg/kg (max 50 mg) every 4-6 hours for 24 hours
Antidote: ethanol or fomepizole
GI decontamination NOT recommended
What is the major sign of methanol toxicity?
Visual disturbances
What are the downsides of ethanol?
- Requires central venous catheter
- CNS depression
- Respiratory depression
- TDM
What are some pearls of fomepizole?
- Less dosing errors and monitoring compared to ethanol
- BUT 4x as expensive
When should antidotes be continued until?
Toxic alcohol concentration <25 mg/dL
What is the 2nd most reported exposure in children?
Household cleaners (bleach, detergent, soap)
Caustics (toilet/drain/oven cleaners)
How should cleaner exposure be treated?
Supportive care
Consider PPI for GI injury
No antidote and GI decontamination is NOT recommended
How should foreign body ingestion be treated?
Manual removal if esophageal impaction suspected
How long does it take for a disc battery to pass through the digestive system?
1-2 weeks
What are s/s of disc battery ingestion?
- Vomiting
- Diarrhea
- Abdominal pain
- Fever
- Refusal to eat or drink
- Dysphagia
What is the phone number for the National Battery Ingestion Hotline?
1-800-498-8666
What is the poison help phone number?
1-800-222-1222
Should cough and cold preparations be used in children to manage cold symptoms?
No, little evidence supports it
FDA recommends avoiding these drugs in children under 6 years
How should cough/cold prep ingestion be treated?
Activated charcoal
Symptom management:
- Labetalol, nicardipine (HTN)
- Amiodarone (arrhythmias)
- Benzodiazepines (seizures)
