1. ACCIDENTAL POISONING IN CHILDHOOD (2).ppt

Poisoning in children

1. ACCIDENTAL POISONING
IN CHILDHOOD
Prof. Gracia EKE
Oncology / Social Paediatrics Unit
University of Port Harcourt teaching Hospital

2. Learning Objectives
At the end of this lecture, learner will be able to:
i. Identify risk factors of childhood poisoning
ii. Recognize the common causes and recommend
preventive measures for childhood poisoning
iii. Apply the principles of management of childhood
poisoning
iv. Manage a child presenting with kerosene
poisoning
v. Recognize the common causes and recommend
preventive measures for household accidents
vi. Discuss management of dog bite

3. INTRODUCTION
•Poison: toxic substance causing cell injury or
destruction when it gets into the body
•Accidental poisoning: cause of morbidity and
mortality in children
•Results from ingestion, injection, inhalation or
contact with poisons; usually with most frequently
available household chemicals
•Circumstances of poisoning:
- accidental: especially in U-5 age group-10%
- suicidal (intentional): in older children- 80%
- homicidal: 10%

4. EPIDEMIOLOGY
•Conditions for accidental poisoning:
–available poison
–susceptible host
–facilitating environment
•Incidence varies from country to country and
from place to place
•M>F
•Usually the result of inadequate supervision or
improper storage of poisons

5. EPIDEMIOLOGY
•Childhood poisonings:
- unintentional: 88%
- occur in the home: 92%
- produce no toxicity: 82%
- produce minor toxicity: 17%
- fatal: 0.01% (4 x higher in LMIC, highest in U-5)
- ingestion: 77% / dermal, inhalation, ophthalmic
- non-drug substances: 50%
•Severity / outcome depend on: nature, dose,
formulation, route of exposure, age,
• pre-existing health condition

6. RISK FACTORS
•Young age: 1-4 years, males
•Unsupervised home setting
•Easy access to poisons (lack of storage space)
•Parental ignorance, illiteracy
•Families with stresses, substance abuse
•Socio-cultural habits, socio-economic status
•Working parents
•Attractive nature of some preparations
•Self medication, indiscriminate dispensing of drugs
without doctor’s prescription

7. SOME AGENTS OF POISONING

8. GENERAL SUPPORTIVE AND THERAPEUTIC
MEASURES
•Poisoning is an emergency
•Identify the poison:
- only few produce characteristic signs
- accurate history may not always be available:
-substance suspected, mode of exposure,
quantity, time interval
- symptoms/signs: vomiting, shock, level of
consciousness (Glasgow coma scale), odour,.....

9. GENERAL SUPPORTIVE AND THERAPEUTIC
MEASURES - contd
•Diagnosis:
- primarily clinical
- visual identification: label, shape, size, colour
- laboratory identification:
- quantitative identification of substance in
gastric aspirate, blood or urine: definitive
diagnosis
- chemical analysis of most poisons: require
elaborate lab equipment and specialised
techniques

10. BASIC PRINCIPLES OF
MANAGEMENT

11. 1- Intensive/supportive therapy
•ABC (Airway, Breathing, Circulation) and other vital
functions, once necessary, takes precedence over all
other aspects of management
•- respiratory failure: artificial ventilation, stimulant
- shock, convulsion, correct acid-base derangement
- monitor temperature frequently: hypo/hyperthermia
- relieve pain, prevent 2⁰ bacterial infection
- for corrosive/caustic alkali: weak acid (vinegar);
acids: milk, water

12. 2 - Prevention of further absorption of poison /
Decontamination
a) Removal of poison:
•Flushing affected area : dermal, ocular
• inducing emesis:
- inserting finger in the pharynx
- ipecac syrup: 15mls in 200mls of water-
no longer recommended
- apomorphine

13. 2 - Prevention of further absorption of poison /
Decontamination - contd
•Contra-indications to emesis: unconscious child,
convulsing patient, cases of corrosive poisoning,
hydrocarbon because of risk of inhalation
causing aspiration pneumonitis
•Never for corrosives as it may cause respiratory
irritation & more GIT damage specially
esophageal
•gastric lavage: seldom indicated, only if
administered within 1 hour of the ingestion

14. 2 - Prevention of further absorption of poison /
Decontamination - contd
b) Activated charcoal (single dose): -
-adsorbent, also serves as a useful adjunct to
emesis/gastric lavage
- however, its routine use of activated charcoal
is discouraged, except within one hour of
ingestion
c) Whole bowel irrigation

15. 3- Enhancement of elimination
•To reduce the duration of contact of drug with
receptor site
a) Activated charcoal: multiple doses
b) Forced alkaline diuresis: useful in salicilates
and phenobarbitone poisoning
c) Peritoneal/ Haemodialysis

16. 4- Administration of an antidote
•2 types:
- combines with the poison, making it
unabsorbable or less poisonous
- counteract the effect of the poison after
absorption
•Only about 2% of poisons have antidotes

17. PREVENTION
•Health education for parents
•Improvement of socio-economic condition
•Behavioural change in storage of drugs and
household products
•Avoid storage in beverage bottles or colorful
containers which attract children
•Drug preparation: coated tab, child-resistant
container
•Immediately seek medical care
•Establishment regional poison control centres

18. HYDROCARBON (KEROSENE) POISONING
•Kerosene: most frequently available hydrocarbon to
children
•Found in most homes, used for lighting and cooking
•Usually only small amount ingested because of
unpleasant taste: 30-90 mls
•Absorption: rapid after inhalation or aspiration with
consequent severe respiratory complications
•Highly volatile, low viscosity, low surface tension
with easy spread to lung parenchyma

19. KEROSENE POISONING: Clinical features
- Age: 1-3 years
- chemical pneumonitis: tachypnoea, cough,
wheezing, choking, cyanosis, dyspnoea.
Resp symptoms can develop within minutes of
ingestion, up to 6 hrs
- GIT symptoms: abd pain, nausea, vomiting,
diarrhoea
- CNS manifestations: usually from hypoxia and
acidosis following pulmonary injury:
convulsion, coma

20. KEROSENE POISONING: Treatment
- Many remain well, need no treatment
`- Emesis or gastric lavage should not be attempted
- CXR: mandatory for symptomatic patients,
delayed until 6 hrs or longer after exposure
- Hospital admission for observation for at
least 6 hours
- if signs of pneumonitis, ampiclox, O₂
- steroid: not effective and may increase risk of
infection

21. KEROSENE POISONING: Complications
- Pneumothorax
- Pneumatocoeles
- Pleural effusion
- Bronchopneumonia
- Acute hepatic failure
- Renal tubular necrosis
- Coma
- Death

22. HOUSEHOLD ACCIDENTS
•Major cause of death and disability among
young children
•Most of these accidents happen in or near the
home
•Almost all can be prevented if parents and
caretakers watch young children, especially
U-5 carefully and keep their environment safe

23. Main causes of household accidents:
•Burns (F>M) from fires, stoves, cooking pots, hot
foods, boiling water, steam, kerosene lamps, iron
•Cuts from broken glass, knives, scissors, sharp or
pointed objects
•Falls from furniture, windows, stairs, playground
•Choking on small objects: coins, beads, nuts, toys
•Electrical shock from touching broken electrical
appliances/wires, pocking sticks or knives into
electric outlets

24. Main causes of household accidents

25. Childhood
drowning
•Can happen quickly and
quietly
•Infants: most likely to
drown in bathtub, bucket..
•Children 1-4, mostly in
home swimming pools
•Drowning in natural water
settings increases with age
•Near drowning: severe
cases brain damage,
learning disabilities,
permanent loss of basic
functioning
•Prevention : ......

26. Main causes of household accidents:
Texting pedestrians 4x more likely
than undistracted ones to display
unsafe crossing behaviours

27. DRUG POISONING
•Improper use of illicit drugs or medicine that is
either prescribed or over-the-counter
•Higher rates of deaths in (US):
- males than females
- urban than rural areas
•Common ones: iron, salicylate, acetaminophen,
recreational drugs or substance

28. BITES
•Saliva or venom of some living creatures through
bites, stings and envenomations can cause toxic
reactions
•Depend on exposure, provocation and species of
insects or animals involved
•Most reactions produce local inflammation with
little progression or systemic manifestations
•Some reactions may represent allergic responses
to insect antigens, others may result in tissue
necrosis, infection, paralysis and death

29. DOG BITE
•Stray dogs: public health hazard - 90% of cases of
rabies transmission
•Human rabies: endemic in Nigeria, caused by
Lyssavirus rhabdoviridae
•5-14 year old: mostly affected
•Transmission: close contact with infected saliva
•Incubation: 1-3 months, but few days-some years
• Highly neurotropic virus. Enters peripheral nerves,
travels along motor/sensory axons to spinal ganglia
and into brain, then spreads to peripheral and
salivary glands.

30. DOG BITE
CLINICAL FEATURES
•Initial: fever, pain or
paraesthesia at wound site
•Delirium, psychosis, restlessness
•Muscular fasciculation, seizure
•Aphasia
•Hydrophobia, aerophobia
(laryngeal/diaphragmatic
spasms, sensation of asphyxia)
•Paralytic form
•Furious form
•Ds: viral cultures (saliva, urine,
CSF)
MANAGEMENT
•Post-exposure prophylaxis:
•Washing, wound debridement
•A/biotics
•If risk factors (unprovoked bite,
sick dog or with abnormal
behaviour or unimmunised or
known rabies carrier):
•Human Rabies Immunoglobulin
•Rabies vaccine (5 doses)- on
days 0,3,7,14,18
•Established rabies- fatal:
Sedation, counselling

31. THANK YOU