poison in children

for family medicine doctors, G pediatrician, medical students

1. Evaluation and management of the poisoned child Dr Hussein Abdeldayem , MD Professor of Pediatrics. Alex Egypt

2. introduction Circumstances of poisoning : 1-Commonly accidental especially in the under-5 age group . 2- homicidal. 3-suicidal (in older children)

3. mortality: Death is increasingly rare due to more effective management &preventive measures.

4. Routes of administration of the poisons

5. A-Non specific management: 1- removal of the source of poison away from the child . 2- initial resuscitation and stabilization. 3- removal of unabsorbed poison from GIT. 4- elimination of already absorbed poisons. 5- symptomatic and supportive measures.

6. 1-removal of the poison .

7. 2-Initial resuscitation and stabilization: it is the initial priority in treating poison children. A :Assess airway patency. B :Assess the adequacy of breathing .

8. C : Assess the circulation in terms of 1-cardiovascular status . 2-effect of circulatory inadequacy to other organs

9. D : Assess neurological function in terms of : -level of consciousness -pupillary size and reaction -bedside blood glucose concentration. -presence of any seizure activity. E : Record the child's temperature.

10. 3-removal of unabsorbed poisons from the GIT. 1- Activated charcoal (AC ): it is the safest mode. It is given if the child has taken a potentially toxic overdose within the previous hour.

11. Mechanism and dose : It adsorbs many toxins (except metals, alcohols & petroleum distillates) & reduces its absorbtion into the bloodstream. Dose : 1 g/ kg.

12. Disadvantage : It is an odorless , tasteless, black powder so Children may be averse to its gritty texture & color. if they cannot be cajoled with flavoring , an opaque cup, and straw, then it can be administered by a nasogastric tube.

13. 2- Gastric lavage : usually reserved for children who present within 1 h of ingesting a potentially life-threatening poison .

14. disadvantage: It is often difficult to remove the toxic agent from the GI tract because of the small size of lavage tube needed in pediatric patients. the child will often need to be intubated to facilitate this technique.

15. alkalis hydrocarbons acids contraindicated

16. 3- Whole-bowel irrigation: Irrigation is a newer technique used to flush the toxin through the bowel , thereby preventing further absorption .

17. Polyethylene glycol 500 ml /h is given orally & continued until the rectal effluent is clear (in 4-6 h). serial abdominal radiographs may also be used to demonstrate its effectiveness.

18. It is particularly useful for ingestions that are not adsorbed by AC such as: Lead paint batteries iron tablets

19. Symptomatic Rx hypotension arrhythmia convulsions Pain hypothermia

20. 5-elimination of the already absorbed poisons. Absorption of poisons occurs after six hours after ingestion. The techniques are :

21. Kerosene poisoning

22. Kerosene poisoning is common in communities where kerosene is a major household fuel. The circumstance is usually accidental ingestion (mistaken for water)

23. Investigations to aid management and to monitor complications in other organ systems we do:

24. Chest x-ray is done in all symptomatic patient to : 1- determine the extent of injury . 2- rule out differentials which include - atelectasis -inhalation injury -Near Drowning -Pneumonia -Respiratory Distress syndrome

25. Perihilar opacity Bi-basal infiltration Initially the chest radiograph may be normal but positive findings develop over the first few hours after ingestion of kerosene. Common findings include perihilar opacities and bi-basal infilteration .

26. Treatment : maintenance of airway, breathing and circulation. Stabilization of the airway is always the first priority of treatment.

27. Gastric lavage and induction of emesis ( e.g. use of Ipecac) should not be considered in the management of kerosene poisoning as these may cause further aspiration and worsens the condition.

28. Corrosives Substances that cause tissue damage by chemical reaction

29. Inorganic non metal : Acids as sulfuric acid and hydrochloric acid. Bases (alkali)as ammonia, k permenganate . Organic non metal: - Carbolic acid and oxalic acid. Classification of corrosives :

30. PH of saliva should be checked by PH paper. Endoscopy is the only reliable way to establish the severity of esophageal burn. It should be performed from 12- 24 hours after ingestion. (contraindicated if there is suspecting perforation) Investigations

31. Routine investigation :Complete blood count, glucose and electrolyte determination level. Chest and abdominal X-ray should be taken to rule out visceral perforation. Ocular slit- lamp examination with topical fluorescein dye in cornel burns.

32. Treatment

33. Thank you