POISONING IN CHILDHOOD Flashcards
What is poisoning?
Poisoning is exposure to a substance that is toxic to a human being.
Risk factors for poisoning (5)
1)Age:Most cases occur below 5 years of age. Poisoning in older children are often: Less common, Intentional (suicide,drug abuse)
2)Sex:Accidental poisoning is more common in males due to their more adventurous and inquisitive nature.
3)Poor parental supervision
4)Learning disability
5)Parents who abuse substances
Routes of poisoning (4)
1)Most poisoning occur through ingestion (77%)
Other routes of poisoning:
2)Dermal (8%)
3)Inhalation (6%)
4)Ophthalmic (5%)
Common poisons;
Approximately 50% of cases of poisoning involve non-drug substances like??? 50% are Pharmaceutical products like??
Approximately 50% of cases of poisoning involve non-drug substances like:
Hydrocarbons (kerosene),
cosmetics,
Caustic soda
personal care items,
cleaning solutions,
plants and foreign bodies.
50% are Pharmaceutical products like:
Analgesics (PCM, aspirin)
Haematinics (Iron tablets)
Cough & cold relievers,
Oral hypoglycaemic agents
Antimicrobials and
Vitamins supplements
ALCOHOL exists in form of?? (3)
The most frequently abused is?? And it’s sources??
Alcohol exists in form of:
ethanol
methanol and
isopropanol.
The most frequently abused is ethanol.
Sources of ethanol include locally brewed gin, refined alcohol e.g. brandy, whisky and wine.
Other alcohol containing items include ??
The most common mode of alcohol poisoning is??
Other alcohol containing items include perfumes, aftershave, mouth wash and paint removers.
The most common mode of alcohol poisoning is when children drink (usually out of the bottle) in the absence of their parents.
Pathophysiology of alcohol poisoning
Ethanol is rapidly absorbed from the stomach and small intestine reaching peak plasma levels within 30-60 minutes after ingestion.
Ethanol is metabolized predominantly by the liver.
Alcohol dehydrogenase converts ethanol to acetaldehyde which is further metabolized into acetic acid and then to carbondioxide and water.
Only 2-10% of ingested ethanol is excreted through the kidneys.
The lethal dose of ethanol in children is 3mg/kg compared to 5-8mg/kg in adults.
Signs of alcohol intoxication appear in children at blood alcohol levels of 50mg/dl.
Clinical features;
In severe alcohol poisoning, there is usually hypoglycaemia.
Other features include muscle incoordination, drowsiness, slurred speech, blurred vision and hypothermia.
In severe toxicity, there can be apnoeic attacks and coma.
There may be convulsions, resulting from hypoglycaemia.
Treatment
Since alcohol is rapidly absorbed, gastric aspiration is usually not useful.
Treatment of proven or suspected hypoglycaemia, is with IV 10% dextrose infusion.
Metabolic acidosis is treated with IV sodium bicarbonate
In patients with apnoeic attacks, ventilator support is useful.
Haemodialysis is indicated if there is severe metabolic acidosis or ethanol blood levels >50mg/dl
Hydrocarbon poisoning;
Hydrocarbons include:
most frequently available to children
Hydrocarbons include:
kerosene,
petrol,
lighter fluid,
paint thinner e.g. Turpentine
cleaning agents and
furniture polishes.
Of all these, the most frequently available to children is kerosene:
Pathophysiology of hydrocarbon poisoning
The most important toxic effect of hydrocarbons is aspiration pneumonitis.
•Aspiration usually occurs at the time of ingestion when coughing or gagging but can also result from induced vomiting after ingestion.
•Because of the low viscosity and high volatility of hydrocarbons, only a small quantity (<1ml) needs to be aspirated to cause significant lung injury.
•Most hydrocarbons have anesthetic property and can cause transient CNS depression.
•Pathologic changes in the lungs in kerosene inhalation include:
–bronchospasm,
–atelectasis,
–emphysema,
–bronchiolar oedema and
–necrosis.
•Secondary bacterial infection may be a complication.
Clinical/laboratory manifestations of hydrocarbon poisoning
Mild CNS depression.
•Aspiration pneumonitis manifests as cough, dyspnoea, wheezing, choking and chest retractions.
•GIT symptoms include nausea, vomiting, diarrhoea.
•Pneumatoceles may appear on the chest x-ray 2-3 weeks after exposure.
•CCF, headache, vertigo, ataxia, euphoria, and renal & hepatic damage may also be seen acutely
Treatment of hydrocarbon poisoning
All children who ingest kerosene must be observed for at least 6hrs in the hospital after which they can be let home if there are no symptoms.
•If there are signs of chemical pneumonitis, the child should be treated with antibiotics as the lungs can become secondarily infected. (Penicillins are helpful)
Oxygen and ventilation may be required for respiratory failure.
•Avoid corticosteroid
•Contraindicated:
–Gastric lavage
–forced emesis
–Mineral oil
these can lead to more aspiration of the hydrocarbon.
What is considered the toxic dose of IRON POISONING?
•The severity of toxicity is based on the amount of elemental iron ingested:
–Greater than 60mg/kg of elemental iron is considered the toxic dose.
Pathophysiology of iron poisoning
Iron is corrosive to the gastrointestinal mucosa and may lead to:
•intestinal ulceration, oedema and occasionally melena,
•haematemesis and
•possible perforation.
•Iron also accumulates in mitochondria thus it can produce systemic effects
Iron causes:
•venodilation and
•increased capillary permeability leading to
•Hypotension
•Metabolic acidosis.
•Hepatic necrosis develops after serious poisoning resulting in:
•abnormal liver function tests
•Coagulopathies
•Altered sensorium.
