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 the 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).