Sudden Infant Death and Poisoning Flashcards
What is sudden infant’s death?
Sudden infant death syndrome is infants’ deaths that were sudden and upon autopsy no cause was found. This definition is in children who are under 1.
What are the risk factors for sudden infant death?
1-4 months old Poverty Parents that smoke Male baby Prematurity Winter Previous history Coexisting minor URTI Sleeping prone and separate from parents’ room Co-sleeping
What are the common causes of sudden infant death?
Inhalation of milk Airway oedema Passive smoking Faulty CO2 drive Prematurity Brainstem gliosis Long QT interval Staph infection Overheating Increased vagal tone or raised Mg Immature diaphragm
How should a case of sudden infant death be dealt with directly after the failed resuscitation?
Document all interventions, get external party to check endotracheal tube position.
Keep clothing and nappy
Explain clearly to parents that despite best efforts the baby has died
Unless cause is known the baby has to have an autopsy
How should you manage the mother after a sudden infant death?
Don’t automatically supress lactation but if necessary cabergoline is preferred but continued lactation may be an important part of grieving for the parent.
Advise regarding likely grief reactions including guilt, anger, loss of appetite, hearing the baby cry.
Care of next infant may require apnoea alarms and other programmes to help the parents.
When are accidental overdoses/poisonings most likely to occur?
Most common in children by accident between ages of 2-3. If older consider if this could be a suicide attempt.
How should you take a history from a child/parents of a suspected poisoning?
What, when, how many
What’s total possible dose taken
Could anything else have been taken with it?
Could any other children have been involved
How should you investigate a potential paediatric overdose?
Use Toxbase.org to look into antidotes and management for specific poisoning/overdoses.
Blood glucose
U&E, LFT, FBC
ECG
Blood gas – metabolic acidosis with increased anion gap could be: metformin, alcohol, ethylene, toluene, cyanide, isoniazid, iron, aspirin and paraldehyde.
If possible, measure drug levels in serum
How are overdoses managed?
ABCDE
Consider intubation
Common drugs and their antidotes
Beta-blockers – atropine, glucagon, and consider adrenaline
Carbon monoxide – high flow oxygen and mannitol
Digoxin – Digibind (digoxin specific antibody) otherwise atropine of bradycardic
Opioid – Naloxone
When does iron poisoning occur?
Poisoning occurs when transferrin binding capacity is reached.
How does iron poisoning present?
Nausea, vomiting, diarrhoea and haematemesis
Altered mental status and hypotension
Improvement may transiently occur between 6-12 hours
From 12 hours Cardiovascular collapse and massive GI bleeds
Metabolic acidosis as all Fe oxidised releasing protons
This leads to renal and hepatic failure
How should iron poisoning be managed?
Chelation with IV desferrioxamine stop once acidosis improves (note this causes red urine)
Get senior help as gastric lavage or endoscopy may be indicated
Whole bowel irrigation may help
IV fluids and sodium bicarbonate
Hemofiltration can be used
What is salicylate poisoning?
Most commonly this is as a result of aspirin (not recommended in children due to association with Reye’s syndrome). Toxicity occurs at 100mg/kg of aspirin.
How does salicylate poisoning present?
Tinnitus and hearing loss
Tachypnoea and respiratory alkalosis due to stimulation of respiratory centre
Interference with aerobic metabolism eventually leads to metabolic acidosis
GI upset including, diarrhoea, nausea and vomiting
Agitation, delirium and seizures
When should salicylate levels be measured?
Salicylate levels best obtained at 6 hours post intake and then 2 hourly from then
