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.
· 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).