Poisoning Flashcards
What clinical presentations could indicate poisoning?
Any child who presents with unexplained symptoms including altered mental status, seizure, cardiovascular compromise, or metabolic abnormality should be considered to have ingested a poison until proven otherwise.
What is important in directing interventions?
Determination of all substances that the child was exposed to, type of medication, amount of medication, and time of exposure
What are the most common agents?
- Cosmetics
- Personal care products
- Cleaning solutions
- Analgesics
- Plants
- Foreign bodies
- directly accesible in the childs environment
Epidemiology of poisoning?
- 50% occur in children <6 yr old, with the highest number of exposures occurring in 1 and 2 yr olds
- Almost all these exposures are unintentional and reflect the propensity for young children to put virtually anything in their mouth (unintentional, exploratory ingestions.) - 6-12 yr are much less common, involving only approximately 10% of all reported pediatric exposures
- 2nd peak in pediatric exposures occurs in adolescence
Why poisoning in <5 years is common?
- Curious
- Explore environment using all senses
- Prone to mouthing things
- Lack of sense of danger
Why poisoning in adolescence happens?
- Usually deliberate ingestion
- Deliberate self harm
- Exploratory behaviour (recreational drugs)
Note: Poisoning in middle childhood (age 6–11 years) is rare
Routes of poisoning?
- Ingestion
- Inhalation
- Ocular exposure
- Dermal exposure
- Mucous membrane involvement
- Parenteral exposure
History taking on environment of poisoned patient?
- witness
- time of ingestion
- site of ingestion
- illness of family member
- medication of family members
- open containers
History taking of a poisoned patient?
- intentionally
- past medical history
- current medications
- known drug allergies
- time of symptom onset
- prior medical management
- substance found in the patients hand or mouth
History taking for the poisonous toxin?
- agents involved
- exact ingredient
- dose - max
- concentration - strength
- route of exposure
- formulation - enteric coated or extended release
Past medical hx in poisoning?
- psychiatric illnesses
- pregnancy in teens
Social hx in poisoning?
- social environment (caregivers, visitors, grandparents, recent parties or social gatherings)
- social circumstances (new baby, parent’s illness, financial stress)
- neglect
What should parents do in the event of poisoning?
Parents should bring the product containers and medication labels
- Parents may minimize their description of the child’s exposure to a toxin in an attempt to deny the threat of injury or to assuage their guilt that such an episode occurred
Odor signs of poisoning and causes?
- alcohol - ethanol
- garlic - organophosphate
Ocular signs of poisoning and their causes?
- miosis - organophosphates
- mydriasis - atropine, antihistamines
- nystagmus - phenytoin, barbiturates
- lacrimation - organophosphates, irritant vapor/gas
Cutaneous signs of poisoning and causes?
diaphoresis - Organophosphates, muscarinic mushrooms, aspirin
Oral signs of poisoning and their causes?
- dry mouth - amphetamine, anticholinergics, antihistamine
- burns and dysphagia - corrosives
- salivation - Organophosphates, salicylate, corrosives, ketamine
- hematemesis - Corrosives, iron, salicylates, NSAIDs
Intestinal signs of poisoning and their causes?
diarrhea - Antimicrobials, iron, cholinergics
Respiratory signs of poisoning and their causes?
- depressed resp. - Alcohol, narcotics, barbiturates
- increased resp. - aspirin, CO
- pulmonary edema - Hydrocarbons, organophosphates
Mechanism of action of CO poisoning?
- CO binds reversibly to hemoglobin with about 250 times greater affinity than oxygen
- In addition, CO has an even higher affinity for cardiac myoglobin, further worsening cardiac output and tissue oxygenation