POISONING IN CHILDREN Nearly always accidental Common once: kerosene Cleaning agents CO Prescription medication
Always kept in mind even in absence of history of poisoning
Basics : Confirm Identify quality Route & quantity Time Illness or drugs before
possible features : Coma Convulsion Arrhythmias GI symptoms Acidosis Odor Color sweating Dryness Gray cyanosis Eye changes Fever
Investigations Blood counts, gases & osmolality ECG Chest & abdominal x-ray Toxicology
Management ABC & IV access Monitoring Removal cleaning Lavage Ipecac Charcoal Antidote
Prevention 1)Protection of the child by: X child reach places X wrong containers child proof packing 2) Parent education potential household poisons Toddler supervision Information's on management
KEROSENE POISONING Most common here & least common elsewhere Affects lungs & CNS Both vomiting induction & lavage are contraindicated Charcoal is not effective ? Steroid & antibiotic
PARACETAMOL POISONING More than 150mg/kg is hepatotoxic Clinical stages Day 1: GI symptoms Day 2: rising TSB,SGOT,SGPT & PT Day 3,4&5: peak hepatotoxicity Day 6&7: possible recovery Treatment ; charcoal & NAC
TRICYCLIC ANTIDEPRESSANTS POISONING Cardiac effects CNS effects Anticholinergic effects Treatment; Lavage Charcoal Treat convulsion Treat cardiac effects: IV normal saline Induce alkalemia Lidocaine Defibrillation
IRON POISONING More than 40mg/kg is toxic Toxic effects on; GI CVS CNS Metabolic Liver
Iron poisoning (continued) Clinical phases: Phase 1 (1 st 6hr.) : bloody diarr. & abd. Pain Phase 2 (6-24hr.s): apparent recovery Phase 3 (24-48r.s): shock,acidosis,convulsion, liver affection Phase 4 (4-6weeks): GI stricture, hepatotoxicity
Iron poisoning (continued) Treatment: GI decontamination General supportive care Chelation Dialysis Exchange transfusion
CAUSTIC POISONING Acids……….coagulation necrosis Alkalis……..liquefaction necrosis Drooling, stridor, dysphagia & erythema -+ ulceration Treatment: Irrigate No induction of vomiting Oral dilute milk or water ? Steroid Esophagoscopy
SALICYLATE POISONING More than 150mg/kg is toxic Respiratory alkalosis…………metabolic acidosis Tinnitus,fever,coma & circulatory collapse Treatment: Lavage up to 4hours Charcoal Fluid & electrolyte Vitamin K, ? Blood, FFP & clotting factors Forced alkaline diuresis Hemodialysis
CO POISONING Causes cellular anoxia by: o Displacing O2 on Hb o Shifting to left causes decrease O2 delivery at tissues o Affecting function of intracellular cytochrome oxidase
CO poisoning ( continued) Other effects: Bronchopulmonary CNS Cardiac Muscles Skin
CO poisoning ( continued) Treatment: 100% O2 under pressure 5 hr. in room air 1 hr. in 100% O2 30 min. in 100% O2 under pressure
SMOKE INHALATION Causes upper airway burn( hot smoke) & cellular hypoxia ( from bronchopneumonia, CO & cyanide) Treatment: ETT, O2 & Na thiosulfate
LEAD POISONING Paint batteries printing Surma Pica Encephalopathy, bone lines, resistant anemia Treatment: Removal of source Decontamination Chelation( BAL)