Poisoning

-intentional or accidental ingestion of substances that can be a solid object, a toxic or potentially toxic substance or a corrosive liquid or solid. - Most commonly occur in children between the ages of 2 and 3 years and all socio economic group.

Dilated Pupils Metabolic Acidosis Hyperthermia or Hypothermia Lethargy Unexplained Cyanosis Seizures Cardiovascular Collapse Coma

Common Agents
Soaps Cosmetics Detergents or Cleaners Plants Over-the-counter Drugs Vitamins Iron Compounds Aspirin Acetaminophen

Management at Home
Parents should telephone their local poison control center to ask for advice instead of using syrup of icepac to induce vomiting according to the American Academy of Pediatrics. Informations needed are: Childs name, telephone number, address, weight and age and what the child swallowed How long ago the poisoning occurred. The route of poisoning. How much poison the child took. The childs present condition.

Prescription Durgs Anti-depressants

Manifestations
*Depends on the substance ingested Acute Abdominal Pain Nausea Tachycardia or Bradycardia Salivation Diarrhea

Emergency Management at the Health Care Facility Administer Activated Charcoal to deactivate the poison

Points to consider in administering Activated Charcoal: It is mixed with water during administration.

General Diagnostic Protocol

Parents should be instructed to bring the battle or contents of the agent ingested for evaluation. Vomitus may be sent for drug, substance or pH analysis. Drug Screening may be obtained, analysis for heavy metal should be ordered. CBC count, Urinalysis, Chest Radiography, Blood Gases, Electrolytes, BUN, Creatinine and Liver Function Testing May be Iindicated.

A sweet syrup may be added to the mixture to enhance taste. Store the drug in a close container, because it absorbs gases in the air and becomes inactivated. Caution parents that stools will appear black in the next 3 days.

Nursing Management
Monitor child during decontamination procedure and until stable. Provide emotional support to child and family. Provide anticipatory guidance related to childproofing the home, especially regarding potential sources of poisoning.

Provide Supportive Measures IV fluids to maintain good urine output Oxygen, if necessary Anticonvulsants, if seizures are present Cardiorespiratory support, if required

Lead Poisoning
One of the most common forms of poisoning in pediatrics. It results from ingesting or inhaling lead-containing substances.

Specific Antidotes or Regimens for Specific Toxins Dialysis (If poison is dialyzable) Peritoneal Dialysis Hemodialysis

Sources of Lead
Paint chips Powder from paint Gasoline

 Unglazed ceramic containers Lead Crystal Water from lead pipes Batteries Folk Remedies Fishing weights Furniture refinishing supplies Art supplies Cosmetics

- high-dose lead exposure causes lead encephalopathy

Diagnostic Tests
a.) Lead tests will reveal a serum lead level exceeding 10mg/dl b.) Elevated ERYTHROCYTE PROTOPORPHYRIN levels were considered positive for lead poisoning

Nursing Management
1. Minimize the consequences of lead exposure a.) Monitor the child for manifestations of lead toxicity. b.) Administer chelation therapy, as prescribed. -Succimer (Chemet) -Dimercaprol (BAL) -Edetate calcium disodium c.) Prepare the child and family for interventions, which vary according to lead level scores. d.) Encourage fluids to enhance lead excretion. e.) Monitor fluid intake & output to evaluate kidney function. f.) Perform prescribed serial urine testing during chelation therapy to monitor kidney status and the rate and volume of lead excretion. 2. Prevent further exposure to lead.

Assessment Findings
1. Associated Finding. A history of pica may be determined.

2. Clinical Manifestations a.) Hematologic manifestations include signs of anemia. b.) Renal manifestations include glycosuria, proteinuria, ketonuria, and hyperphospaturia. c.) GI manifestations include acute crampy abdominal pain, vomiting, constipation, and anorexia. d.) Musculoskeletal manifestations include short stature & lead lines in bones on Xray films. e.) Neurologic (central nervous system) manifestations -Low-dose lead exposure causes behavioral changes

a.) Provide child and family teaching regarding prevention of lead poisoning such as ~ Ensure that your child does not have access to peeling paint or chewable surfaces that are coated with leadbased paint ~ Wash & dry your childs hands frequently ~ If soil is likely to be contaminated, plant grass, or other ground cover. ~ If you are remodeling an old home, follow correct procedures. ~ Use only cold water from the tap from consumption, esp. when preparing a formula. ~ Have your water and soil tested by a competent laboratory. ~ Do not store foods in opened cans. ~ Do not use inadequately fired ceramic ware or pottery for food or drink ~ Do not store food or drink in lead crystal ~ Avoid folk remedies or cosmetics that may contain lead. ~ Avoid home exposure to lead from occupations or hobbies. ~ Make sure that your child eats regular meals & consumes adequate amounts of iron & calcium. b.) Make a home referral for lead removal.

Pathophysiology
1) Lead, which is very slowly excreted through the kidney, gastrointestinal tract, and slightly through sweat, is stored chiefly in the bone. When the rate of absorption surpasses the rate of excretion, lead is deposited into soft tissues of the body and the bone and attaches itself to red blood cells. In the erythrocytes, it interferes with the production of heme & formation of hemoglobin, which results in a microcytic, hypochromic anemia.

2) Lead affects the kidneys by altering the permeability of the proximal tubules, resulting in increased urinary elimination of glucose and protein. 3) Lead deposits also increase vascular permeability, resulting in fluid shifts that lead to encephalopathy and increased intracranial pressure.