Poisoning ****

Question 1

When is this most often seen?

Answer 1

2-3 yrs of age - consider suicide attempt in older children

Question 2

What should be determined?

Answer 2

What
How much
When it was ingested
Number of tablets
Were there any other medicines or chemicals near them?
Was the child playing with other children? (They could have also ingested something)

Question 3

Examinations - what to look for?

Answer 3

Toxidromes

Question 4

Toxidromes:

Opiods - examples

What it would cause if overdosed?

Answer 4

Morphine 
Codeine 
Methadone 
Oxycodone 
Heroin 

Bradycardia
Hypotension
Decreased RR
Pin point pupils

Question 5

Toxidromes:

Cholinergics - examples

What it would cause if overdosed?

Answer 5

Organophosphates, pilocarpine

Diarrhoea 
Urination 
Miosis 
Bradycardia 
Emesis 
Lacrimation 
Lethary 
Salivation

Question 6

Toxidromes:

Anticholinergics - examples

What it would cause if overdosed?

Answer 6

Antihistamines
Tricyclic antidepressants

Hyperthermia
Facial flushing
Dry skin
Dilated pupils
Delirium
Tachycardia
Urinary retention

Question 7

Toxidromes:

Sympathomimetic - examples

What it would cause if overdosed?

Answer 7

Cocaine
Amphetamines

Tachycardia 
Hypertensive
Hyperthermic 
Dilated pupils 
Risk of seizures

Question 8

Investigations

Answer 8

ABCDE
Intubation if GCS<8
Maintain BP, correct hypoglycaemia, monitor urine output
Blood gases done and sorted
Certain drugs can be measured in blood serum

Question 9

Management

Answer 9

Supportive management
Gastric decontamination - talk with toxicologist
Antidotes if available

Question 10

Antidotes for beta-blockers

Answer 10

Atropine IV for bradycardia, hypotension, heart block and heart failure

Glucagon
Adrenaline/dopamine infusions

Question 11

Antidotes for carbon monoxide

Answer 11

High flow oxygen

Mannitol for cerebral oedema

Question 12

Antidotes for digoxin

Answer 12

Atrophine if bradycardia

Digoxin specific antibody used in severe cases

Question 13

Antidotes for Opiods

Answer 13

IV naloxone

Question 14

Antidotes for Methanol/ethylene glycol

Answer 14

Fomepizole

Question 15

Iron Poisoning Presentation

Management:

What type of flushing is used?
Meds?

Answer 15

N&V
Haematemesis
Diarrhoea 
Altered mental status 
Hypotension 

Gastric lavage / endoscopy to remove tablets
Whole bowel irrigation may help
Supportive care - IV fluids and sodium bicarbonate to correct acidosis
Chelation with IV desferrioxamine

Question 16

Salicylate poisoning

What is the most common salicylate?

What is it associated with in children?

Presentation

Answer 16

Aspirin

Reyes syndrome

Tinnitus
Hearing loss
Stimulation of respect centres leading to tachypnoea and reap alkalosis
Metabolic acidosis

Question 17

Salicylate poisoning

Answer 17

Resus with boluses 
Correct hypoglycaemia 
Potassium IV if hypokaemia 
Sodium bicarbonate for acidosis 
Activated charcoal effective in absorbing aspirin

Question 18

Paracetamol overdose

Presentation

Answer 18

N&V 
Jaundice 
Enlarged tender liver 
Hypoglycaemia 
Hypotension 
Encephalopathy 
Coagulopathy 
Coma

Question 19

Paracetamol overdose

Management

Answer 19

Child could be sent home
Admit those ingesting a big amount and do serum P levels

Acetylcysteine given when confirmed