POISONING IN

CHILDREN
Srushti Patil
Roll no – 10
Msc 1st yr sem 1
 OBJECTIVES
 Define Poisoning
 Enumerate the risk factor of poisoning
 Enlist the most common agents of poisoning
 Enlist the types of poisoning
 Explain about the different type of poisoning
 Enlist the goals of treatment of poisoning
 List down how poison absorption can be prevented
 Enumerate methods to poison proof home
 List down the principles of acute poisoning management
 Explain the management of poisoning in children
 Explain the nursing management of poisoning
INTRODUCTION OF
POISONING

Children are curious & explore their world with

all their sense, including taste. As a result, the
home & its surrounding can be a dangerous
place when poisonous substances are
inadvertently ingested.
DEFINING POISONING

Poisoning is when cells are injured or destroyed by

the inhalation, ingestion. injection or absorption of a
toxic substance. Key factors that predict the severity
and
outcome of poisoning are the nature, dose,
formulation and route of exposure of the poison; co-
exposure to other poisons; state of nutrition of the
child or (fasting status); age and pre-existing health
conditions
RISK FACTORS
Poisoning pattern change according to age group. type of
exposure & nature & dose of the person.

Young children - Particularly susceptible to the ingestion of

poisons, especially liquids, because they are very inquisitive,
put most items in their mouths and are unaware of
consequences.
Adolescents - They are aware but peer pressure and risk taking
behavior can lead them to misuse alcohol or illicit drugs.
Younger children- More susceptible to poisoning because of
their smaller size and less well-developed physiology,
particularly as the toxicity of most substances relates to dose per
kilogram of bodyweight.
 POISONING
*Over-the-counter preparations:
Paracetamol, cough cold remedies, vitamins and iron tablets,
Antihistamines and anti-inflammatory drugs.

*Prescription medications:
Antidepressants, narcotics, analgesics and lit drugs

*Household products:
Bleach disinfectants, detergents, cleaning agents,
cosmetics, vinegar.
 CONT ..

*Paraffin/kerosene.
*Pesticides, including insecticides, rodenticides and herbicides.
*Poisonous plants.
*Animal or insect bites Cosmetic Products.

*Other risk factors:- Related to the poisoning agent itself, including

toxicity, nature, physical appearance and storage;
season and weather conditions;
policies, standards and laws governing the manufacture,
labelling distribution, storage and disposal of poisoning agents.
 TYPES OF POISONING
Ingestion: Medications, solvents, cleaners, etc.
Can be: Alkaline agents: toilet cleaners, non-phosphate
detergents, button batteries, bleach, kerosene, petrol, opium.

Acidic agents: Metal cleaners, Rust removers.

Contact: Poison ivy, sumac, caustic chemicals,
Petroleum distillates/hydrocarbons, Kerosene, Turpentine
Inhalation - Carbon monoxide, Scotch guard.
Animal & insect bite: Pesticides, insecticides
 CONT ..

Absorption via skin

Drug overdose: Paracetamol, poisonous plant.
Food poisoning: Botulism.
Based on duration of exposure
1. Acute: Exposure≤24 hours
-Single: a single or continuous exposure: carbon monoxide -
Repeated: multiple interrupted exposures where there may be
accumulation. (aspirin overdose)
2. Chronic: >24 hours or long term exposure, for weeks or
months
DIFFERENT TYPES OF POISONING

 FOOD POISONING
 CARBON MONOXIDE POISONING
 ORGANOPHOSPHATE POISONING
 OPIOIDS POISONING
 KEROSENE POISIONING
 CARBON MONOXIDE
POISONING
Occur as a result of industrial or household incidents.

Deadly - Carbon monoxide is more reactive with hemoglobin in

red blood cells than oxygen. Binds to hemoglobin
carboxyhemoglobin. it does not transport oxygen.
Since CO Hb releases carbon monoxide slowly, less
hemoglobin will be available to transport oxygen from the lungs
to the rest of the body.

Conversion of most Hb to COHb results in death. Smaller

amounts COHb lead to oxygen deprivation of the body causing
tiredness, dizziness, and unconsciousness.
 CARBON MONOXIDE POISONING

CAUSES CLINICAL MANIFESTATIONS

• Cigarette smoke • CNS symptoms predominate

• House fires • Fatigue, nausea, headache

• • Vomiting
Heaters

• Mental confusion
• Wood-burning stoves

• Muscular weakness
• Internal combustion vehicle exhaust
• Palpitations
• Electrical generators
• Dizziness
• Propane-fuelled equipment such as portable
• Discoloration of skin
• Stoves
• Cessation of breathing , Seizures, Coma
CARBON MONOXIDE
POISONING
COMPLICATIONS
• Seizure

• Hypotension

• Cardiac abnormalities

• Pulmonary edema

• Neuropsychiatric impairment

• Acidosis
FOOD POISONING
Food poisoning is sudden illness that occur after ingestion of
contaminated food or drink.

Symptoms
Nausea, vomiting, Diarrhoea, Bloody diarrhoea or pus in the
stool Upset stomach, abdominal pain, cramps.

Fever that lasts longer than 24 hours.

Dizziness, Fainting, Tachycardia.

Weakness, fatigue.

Numbness or tingling in the arms, legs or mouth.

 ORGANOPHOSPHATE
POISONING
Organophosphate poisoning results from
exposure to organophosphates (found in insecticides) which
cause the inhibition of acetylcholinesterase (ACH),
leading to the accumulation of acetylcholine (ACH) in the
body.

Causes:

• Accidental exposure during spraying insecticides

• Suicidal poisoning
• Homicidal poisoning
• War gas exposure cont..
 ORGANOPHOSPHATE
POISONING

Clinical manifestations

Muscle weakness, fatigue

Muscle cramps and paralysis, hypertension and
hypoglycemia

Central nervous system:

Anxiety, headache, convulsions, ataxia,
depression of respiration and circulation,
tremor, general weakness, and potentially coma.
OPIOID POISONING
An opioid overdose can be identified by a combination of three
signs and symptoms referred to as the "opioid overdose triad".
The symptoms of the triad are Pinpoint pupils,
Unconsciousness, Respiratory depression.

Sign & Symptoms

 Ventricular arrhythmias
 Other signs and symptoms: acute mental status changes,
Seizures
 Bradypnea and hypopnea: rates as slow as 4-6 breaths per
minute.
 Moa: pure opioid antagonist competes and displaces
narcotics at opioid receptor sites.
KEROSENE POISONING
• Accidental kerosene ingestion is still a common problem in
children. It causes considerable morbidity and occasionally
mortality.
• Pulmonary damage has been reported as resulting from
aspiration.
• Kerosene poisoning is said to occur when a child either
swallows or inhales kerosene, intentionally or accidentally.
Kerosene is mainly used in paints, pesticides, fuel lamps and
heating.
• In India most of the cases of kerosene poisoning are
accidental due to its extensive use in cooking and lighting
among people belonging to the lower socioeconomic groups
and its inappropriate storage in soft drink beer bottles.
Cont..
 POISONING
Acute exposure to kerosene by inhalation can result in

 Neurological:- dizziness, ataxia, convulsions, coma, death.

 Respiratory:- pulmonary irritation like coughing and

shortness of breath due to aspiration.

 Heart:- Heart Collapse, Low blood pressure.

 Skin:-Pain with redness, blistering and superficial burns.

 Gastrointestinal:- Intentional ingestion of kerosene can cause

nausea, vomiting and occasionally diarrhea.
 GOALS OF TREATMENT OF POISONING
 To remove or inactivate poison before it is
absorbed.

 To administer a specific antidote to neutralize a

specific poison.

 To implement treatment that hastens the elimination

of the absorbed poison.

 To provide supportive care in maintaining vital

organ systems
 PREVENTION OF POISON ABSORPTION
 Trace out the poison.

 Gastric lavage - warm saline or warm tap water is used.

Gastric aspirate needs to be saved and sent for toxicology
screen.

 Gastrointestinal decontamination:

 Emesis induction: Elicit gag reflex (if patient is conscious)

drink.

 Corrosive poison - water/milk to for dilution.

 Activated charcoal - most effective and safest to prevent
absorption.
 POISON PROOFING YOUR HOME
 Store household products and medicines out of reach and out
of sight of children, preferably in a locked storage area.
Keep medicines in high locked cabinets.

 Store medicines separate from other household products and

keep in original containers.

 All products should be labelled Avoid taking medicine in the

presence of children. Use child-proof packaging.

 Refer to medicines by their proper names, not "candy“.

 Clean out medicine cabinet periodically.

 Flush old medications down toilet.

 PRINCIPLE OF ACUTE POISONING
MANAGEMENT
 1. Initial assessment & stabilization of patient
 2. Definitive care of poisoning cases:

a) Measures to identify the toxic agent.

i. history and circumstantial evidence
ii. symptoms and signs
iii. investigations
iv. postmortem picture
b) Decrease further absorption.
c) Antidote therapy (if available).

d) Enhance elimination (excretion) of toxic substance.

e) Treatment of systemic complications resulting
from poisoning.
 MANAGEMENT OF POISONING IN CHILDREN
In minor poisoning, symptomatic and advanced symptomatic
and supportive treatment are usually not required but for
moderate or severe poisoning treatment are always necessary.
Minor cases are having mild, transient and spontaneously
resolving symptoms.

 Basic Principles of management:-

a) Emergency stabilization measures.
b) Identification of poison.
c) Removal of poisonous substance and toxin.
d) Specific antidote therapy.
e) Promotion of excretion of toxin.
f) Supportive therapy.
g) Counselling to parents and children. CONT..
 STEPS OF MANAGEMENT

1. Establish clear airway and provide ventilatory support, if the

child is unconscious and having respiratory failure.

2. Place the child in semi prone position, if possible to minimize

the risk of inhalation of gastric contents.

3. Assess the child's condition, level of consciousness, features

of complications like metabolic acidosis, hypoglycemia,
hyperkalemia, shock, renal failure, etc.

4. Identify the poison by careful history and find supporting

evidence from the presenting features and physical signs.
 STEPS OF MANAGEMENT CONT..

5. Remove the unabsorbed poison by vomiting or gastric lavage.

-Induction of vomiting is contraindicated in corrosive or kerosene
poisoning, unconscious child and child with absence of gag reflex.

-Precautions to be taken to prevent aspiration during vomiting.

-Activated charcoal can be used as absorbent of the toxic agent in the
GIT.

-Removal of poison needed from the skin and clothing.

-Laxative and purgatives given with substances which do not cause
corrosive action on gastrointestinal mucosa.

-Increased motility of the gut may reduce absorption of poison.

 STEPS OF MANAGEMENT CONT..

6. Administer specific antidote according to the particular toxic agent.

7. Allow increased fluid intake to promote renal clearance by excretion of

poison through the urine.

8. Provide supportive and symptomatic therapy. Oxygen, IV fluid and

medications like anticonvulsive, antipyretics, analgesics, antibiotics may be
needed.

9. Keep all relevant documents and records accurately considering the

medicolegal aspect.

10. Arrange for counselling the parents and children and guide the parents
for regular psychological followup. Teach the parents and family members
about the prevention of accidental poisoning and need for parental
supervision.
 NURSING MANAGEMENT OF POISONING
An important aspect of caring for a poisoned patient understands the course
of management.

On-going interventions include:

 Ensuring airway patency and assessing for the risk of aspiration,

especially after any gastric decontamination process (make sure adequate
suctioning equipment is readily available)

 Checking vital signs and monitoring for hypotension or hypertension.

 Ensuring telemetry monitoring is intact and active (check for ventricular

tachycardia or Brady arrhythmias with hypotension)

 Initiating seizures precautions if necessary.

SUMMARY
Today we learned about Poisoning - its definition, risk
factors, most common agents of poisoning, types of
poisoning goals of treatment of poisoning. We also
discussed how poison absorption can be prevented,
methods to poison proof home, principles of acute
poisoning management and its management and nursing
management.
CONCLUSION
Poisoning is a lethal disruption of body's physiological
mechanism by the induction of an exogenic biological or
chemical agent. A poison is any substance that is harmful to
your body. The effects of poisoning range from short term
illness to brain damage, coma and death. To prevent
poisoning it is important to use and store product exactly as
their labels say. Treatment for poisoning depend on the type
of poison.
 REFERENCES
Dutta Parul," Pediatric Nursing" 3rd edition, Jaypee brothers publication

Suddarth's & brunner-medical surgical nursing 10 edition.

Lippincott williams & wilkins

Dirksen heitkemper levis, medical surgical nursing Mosby 7 edition.

Kumar & clark, clinical nursing 8 editioN

Harrison's principles of internal medicine

Https://medlineplus.gov/ency/article/000948.htm

https://www.who.> injury
THANK YOU
Srushti Patil