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.
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.
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.
·
Acetone.
·
Alcohol.
·
Bitter
almonds (cyanide).
·
Garlic
(heavy metals).
·
Oil of
wintergreen (methyl salicylates).
·
Pears
(chloral hydrate).
·
Carrots
(water hemlock).
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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