Pediatric Toxicity

Question 1

When must you include toxic exposure as part of differential?

Answer 1

Presenting with:
- Altered consciousness
- Metabolic disturbances
- Neurologic dysfunction
- Cardiac/pulmonary distress

Question 2

Which guidelines should you follow for supportive care in pediatric toxicity?

Answer 2

Pediatric Advanced Life Support (PALS)

Question 3

What should be assessed in suspected poisoning?

Answer 3

Serum chemistries and acid-base status

Question 4

What lab is useful for alcohol ingestion?

Answer 4

Serum osmolality

Question 5

What labs are useful for beta blockers or CCBs?

Answer 5

ECG

Question 6

What is the main serum level to check with unknown ingestion?

Answer 6

Serum acetaminophen - easy to do and asymptomatic

Question 7

T/F: Gastric decontamination has a lot of good evidence supporting its use

Answer 7

FALSE: Little data and even discouraged in some guidelines

Question 8

Which gastric decontamination strategies are NOT recommended

Answer 8

• Syrup of ipecac
• Gastric lavage

Question 9

What dose of activated charcoal should be used?

Answer 9

0.5-1 g/kg

Question 10

What are benefits of multiple dose activated charcoal?

Answer 10

• 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

Question 11

When should whole bowel irrigation be considered?

Answer 11

• Sustained release
• Enteric coated
• Iron (or other metals)

Question 12

What should NOT be used for whole bowel irrigation?

Answer 12

MiraLAX (no electrolytes)

Question 13

What dose of PEG+electrolyte should be given for WBI?

Answer 13

0.5 L/hr (small children) up to 1.2-2 L/hr

Question 14

What is acetaminophen toxicity in children?

Answer 14

PO > 200mg/kg
IV >60mg/kg

Question 15

How should acetaminophen toxicity be treated?

Answer 15

AC within 1 hour
NAC IV diluted to 40 mg/mL

Question 16

How should ethylene glycol toxicity be treated?

Answer 16

Pyridoxine 100 mg/day + thiamine 100 mg/day
Antidote: ethanol or fomepizole

GI decontamination NOT recommended

Question 17

How should methanol toxicity be treated?

Answer 17

Folic acid 1 mg/kg (max 50 mg) every 4-6 hours for 24 hours
Antidote: ethanol or fomepizole

GI decontamination NOT recommended

Question 18

What is the major sign of methanol toxicity?

Answer 18

Visual disturbances

Question 19

What are the downsides of ethanol?

Answer 19

• Requires central venous catheter
• CNS depression
• Respiratory depression
• TDM

Question 20

What are some pearls of fomepizole?

Answer 20

• Less dosing errors and monitoring compared to ethanol
• BUT 4x as expensive

Question 21

When should antidotes be continued until?

Answer 21

Toxic alcohol concentration <25 mg/dL

Question 22

What is the 2nd most reported exposure in children?

Answer 22

Household cleaners (bleach, detergent, soap)
Caustics (toilet/drain/oven cleaners)

Question 23

How should cleaner exposure be treated?

Answer 23

Supportive care
Consider PPI for GI injury

No antidote and GI decontamination is NOT recommended

Question 24

How should foreign body ingestion be treated?

Answer 24

Manual removal if esophageal impaction suspected

Question 25

How long does it take for a disc battery to pass through the digestive system?

Answer 25

1-2 weeks

Question 26

What are s/s of disc battery ingestion?

Answer 26

• Vomiting
• Diarrhea
• Abdominal pain
• Fever
• Refusal to eat or drink
• Dysphagia

Question 27

What is the phone number for the National Battery Ingestion Hotline?

Answer 27

1-800-498-8666

Question 28

What is the poison help phone number?

Answer 28

1-800-222-1222

Question 29

Should cough and cold preparations be used in children to manage cold symptoms?

Answer 29

No, little evidence supports it

FDA recommends avoiding these drugs in children under 6 years

Question 30

How should cough/cold prep ingestion be treated?

Answer 30

Activated charcoal
Symptom management:
- Labetalol, nicardipine (HTN)
- Amiodarone (arrhythmias)
- Benzodiazepines (seizures)