Poisoning

Dr.Nabila sherlala
Peadiatric consultent

Objective:
To give general idea about poisoning and
its management

Content:

Definition
Types
Epidemiology
Management
Prevention

Definition:
Poisoning occurs when any substance
interferes with normal body function after
it is swallowed, inhaled, injected, or
absorbed.

Types:
Accidental poisoning(unintentional)
Suicidal poisoning(intentional)
Iatrogenic Poisoning
Acute poisoning
Chronic poisoning

Epidemiology:
>50% occure in children <5y.
>90% of toxic exposure in children occur
in the home
Mostly involve single substance
Route:
1- Ingestion-most common route of
poisoning exposure >75%

2-Dermal 6%
3-Inhalation medical 6%
60% of cases involve nondrug product
>75% of paediatric poising exposure can
be managed without direct medical
intervention.

Mortality due to unintentional poising in

young children is uncommon
-Increase product safety
-Increase poison prevention education
-Early recognition of exposure
-Improvement in medical
management.

Management:
1-History: -Description of toxin
-Magnititude of exposure
-Time of exposure
-Progression of symptoms
-Medical history.

2-Treatment:
ABC
Prevention of absorption:
Gastric lavage.
Activated charcol:
It is containdicated in (heavy metals,
iron,
hydrocarbon, alcohol)
Cathartics- sorbitol,mgsulfate,mgcitrate.
Whole bowel irrigation.

 Enhancing elimination:
1-Diuresis and increase PH of the urine
with IV NaHco3 administration increase
the elimination of weak acid such as
-Salicylate
-Phenobarbitone
2-Dialysis-Haemodialysis
-Peritoneal dialysis
Ex: methanol,salicylate,theophyline

2-Investigations:
Blood level:
salicylate,acetaminophen,iron
urine level- is the best sample.
Basal investigation to asses the GC of the
pt.U/E,LFT,CBC.

Examples:
1-Paracetamol(acetaminophen)
It is the most widely used analgesic and
antipyretic
Toxicity results from the formation of
highly reactive intermediate metabolite(Nacetyl-p-benzoquinoneimine) (NAPQI)

 Acute toxic dose of acetaminophen is

generally considered to be more than
200mg/kg in children <12yr.

Anorexia,nausea,vomiting
Resolution of the symtpms
LFT abnormality
.anorexia,nausea,vomiting
Resolution of hepatic dysfuntion

Stage 1
Stage2
Stage3
Stage4

.5-24hr
24-48hr
72-96hr
4days-2wks

Treatment:
1-General measures
2-Antidote(NAC)

2-Salicylates:
The incidence of salicylate poisining has
declined bec.of use of alternative
antipyretic
Salicylate affect most organ systems by;
-Uncoupling oxidative phosphorylation
-Inhibiting krebs cycle enzyme
-Inhibiting a.a synthesis
-Decrease plat.adhesiveness
-Increase pul.capilary permeability
Toxic dose is >150mg/kg

C/P:
-nausea,vomiting
- Hyperventilation(directly stimulate
respiratory center),leads to resp.alkalosis.
- Metabolic acidosis(bec.of accumalation
of lactic acidosis)
- CNS-agitation,confusion,coma.

Investigation: - Serum salicylate

-urine pH
-ABG,U/E
-Coagulation study
-LFT

Treatment: - ABC
- General measures of
poisoning
- Sever---dialysis

3-Tricyclicantidepresent.
-Block reuptake of
norepinephrine,serotonin,dopamine in
CNS,periphral nerveous system
-Toxic dose is 5-20mg/kg

C/p: affect mainly CNS,CVS

CNS: Drowsiness
Lethargy
Coma
Seizure
CVS:

Tachycardia
Hypertension
Arrhythmia(VT,QT prolongation,
STsegment, complete H.blocke)

Investigation: - ECG monitoring

- Blood level(diagnosis)
Management: - ABC
- General poisoning measures
- Treatment of dysarythmias
- Asymtomatic child should
be kept
under observation at least
6hrs.with ECG monitoring

4- IRON:
One of the most common cause of
childhood poisoning
The potential severity of exposure is based
on the amountof elemental iron ingested
Local effect on GIT(corrosive)
Venodilatation and increased permeability
leading to hypotension
Metabolic acidosis(LA).

Hepatic necrosis: abnormal LFT

Drowsiness, coma
Hemodynamic instability
Direct toxic effect of iron in CNS
Toxic dose> 60mg/kg of elemental iron.

C/P: GIT
Stage I:
nausea,vomiting,diarrhoea,abd.pain.
30min-6h
Stage II: 6-24h
Stage III: > 24h
Stage IV: 2-4wk---gastric scarring, pyloric
stenosis
Inestigation:
Serum iron level
ABG,U/E,blood
sugar,LFT,coagulation study.

Treatment:
- ABC
- general measures of
poisoning
- Desforxamine; mod-sever

6-Hydrocarbon:
The most important toxic effect of
hydrocarbon is aspiration pneumonitis.
Pneumonitis doesn't results from dermal
absorption of hydrocarbon or ingestion in
absence of aspiration
CNS depression
Hepatotoxicity
Renal toxicity

C/p:
Transient CNS depression.
Aspiration pnemonitis:
- coughing
- R/D----R/F
- Fever
Investigation:
C-xray
Treatment:
- ABC
- Gastric lavage, emesis, charcol
CI
- Steroid,antibioticsno role

7-Organophosphorus:
Most pediatric poisoning occurs as the result of
accidental exposure to insecticides in and around
the home or farm.
It bind to cholinsterase enzyme preventing the
degradation of ACH resulting in its accumulation
at nerve synapse.
C/P resuling from accumulation of ACH at periphral
nicotinic and muscarinic synapses and in the CNS.

 Muscarinic:
Vomiting
Urinary,fecal
incontinence
Tearing
Bronchospasm
Miosis
Hypotension,bradycardia

 Nicotinic:
Muscle weakness
Fasciculation
Tremor
Hypertension, tachycardia

CNS:
Confusion,delerium,seizure,coma

Treatment:

ABC
Poisoning measures
Supportive ttt
Antidote-- Atropine

Toxic syndrome
Anticholinergic:

Antihistamine,TCA

Cholinergic(muscarinic,nicotinin)
Organophosphate
Extrapyramidal
haloperidol,metoclopromide,

Prevention:
1-Keep all house cleaning products away
from the reach of children
2-Keep all drugs (syr.,tab.,....) out of reach of
children
3-Change the cap of drug containers.
4-Education of the parents about the risk of
drugs and other toxic products .
5-Educate the family about first aid
managment of poisioning and contact with
poision centers.