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Chapter: Paediatrics: Emergency and high dependency care

Paediatrics: Poisoning

The peak incidence of childhood accidental poisoning is between the ages of 2 and 3yrs.

Poisoning

 

The peak incidence of childhood accidental poisoning is between the ages of 2 and 3yrs. Most cases occur at home. In older children, accidental self-poisoning should be suspected as a possible suicide gesture.

 

Aetiology

 

Parents usually know the name and often have a good idea of the amount of material ingested. Obtain the bottle or container of the ingestant. Get these details in the history.

·  Exact name of the drug or chemical exposure.

 

·  Preparation and concentration of the drug exposure.

 

·  Probable dose (by history) of drug ingested in mg/kg, as well as maximum possible dose.

 

·  Time since ingestion or exposure.

 

·  Check the National Toxicology database.

 

Symptoms and signs

 

There are various signs and symptoms produced by poisoning. It is help-ful to consider the derangement in body systems and think of potential causes. In addition, there are specific odours that may lead to diagnosis.

 

Odours

 

·  Acetone.

 

·  Alcohol.

 

·  Bitter almonds (cyanide).

 

·  Garlic (heavy metals).

 

·  Oil of wintergreen (methyl salicylates).

 

·  Pears (chloral hydrate).

 

·  Carrots (water hemlock).

 

Diagnosis

 

The likely type of poisoning may be indicated by its clinical effect. Bedside or laboratory tests should also be performed.

·  Urinary dip-tests and toxicology.

 

·  Arterial blood gas.

 

·  Blood glucose.

 

·  Co-oximetry (carboxyhaemoglobin level).

 

·  Serum urea and electrolyte.

 

·  Osmolar gap: [osmolality – (2 × Na) + urea + glucose].

 

·  Drug levels.

 

·  ECG: 12-lead for assessment of rhythm and QT interval.

 

·  X-rays: abdomen to detect radio-opaque tablets (e.g. iron).

 

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Paediatrics: Emergency and high dependency care : Paediatrics: Poisoning |

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