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Paediatrics: Poisoning - Management
2021-03-09 12:00 AM
Follow a standard protocol for ABCD and seek advice from your regional or national poisons centre.
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).