Paediatrics: Poisoning: management

Poisoning: management

Initial treatment

Follow a standard protocol for ABCD and seek advice from your regional or national poisons centre.

Gastrointestinal decontamination

Avoid if airway is unprotected. Otherwise consider the following. 

Activated charcoal

·  Oral or nasogastric: 1g/kg is used for substances that can be adsorbed.

·  Do not use when there is risk of aspiration (e.g. bowel obstruction, ileus, absent gag reflex).

·  Do not use after ingestion of alcohol, iron, boric acid, caustics, lithium, or electrolyte solutions.

Gastric lavage

·  May be useful if the patient arrives within 1hr of ingestion (longer if salicylates or iron).

·  Do not use if there has been caustic or hydrocarbon ingestion.

·  Do not use if co-ingestion of sharp objects.

·  The lavage is performed via a large bore gastric tube with normal saline (15mL/kg/cycle, maximum 200mL/cycle) until the gastric contents are clear.

Ipecacuanha

·  Useful within 30min of ingestion.

·  Use 10mL for infants  6mths.

·  Use 15mL for children 1–2yrs.

·  Use 30mL for child  12yrs.

·  Do not use when there has been caustic ingestion.

·  Do not use if the child has altered LOC or is at risk of seizures.

·  After taking ipecacuanha the child should be placed in the prone or lateral position.

Bowel irrigation

·  Nasogastric polyethylene glycol solution (GoLYTELY^® 25–40mL/kg/h for 4–6hr or until clear effluent) is useful after toxic iron, lithium, or lead ingestion.

·  GoLYTELY^® may be useful some hours after ingestion of enteric-coated tablets (salicylates, calcium channel blockers, β-blockers).

·  Do not use in cases of coma when the airway is not protected.

·  Do not use in cases of GI haemorrhage, obstruction, and ileus.

Enhanced elimination

·Urinary alkalinization (pH 7–8) aids elimination of weak acids (salicylates, barbiturates).

·Use IV NaHCO₃ (1–2mmol/kg) followed by increased maintenance fluids (1.5–2 times) with added NaHCO₃.

·Beware of further electrolyte disturbance.

·Haemodialysis is useful for low molecular weight substances that have low volume of distribution and low binding to plasma proteins (aspirin, theophylline, lithium, phenobarbitone, and alcohols).