Paediatrics: Poisoning

2021-04-15 11:05 AM

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 ingested. Get these details in history.

  • The exact name of the drug or chemical exposure.
  • Preparation and concentration of 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 helpful to consider the derangement in body systems and think of potential causes. In addition, there are specific odours that may lead to a 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).