SALALE UNIVERSITY

ABEBECH GOBENA CAMPUS

COLLEGE OF HEALTH SCIENCE

DEPARTMENT OF PEDIATRICS
SEMINAR TITLE: POISONING IN CHIL -
DREN

A D V I S O R A N D M O D U L ATO R : D R G E TA C H E W D .
B Y : A L E M AY E H U A N D
: ANTENEH
10/15/2023 1
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Outline
 Introduction
 Epidemiology
 Routes of poisoning
Approach to poisoned child
 specific common poisoning
prevention

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 Objectives

At the end of this lecture the student will be able

• To Define poisoning.
• To know some common poisoning exposure
• To know the general and specific manage-
ment of common poisoning
• To minimize poisoning in children

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 Introduction
 Poison is any substance that causes harm
when it enters the body or touch the skin.
 Poisoning is exposure to a chemical or other
agent that adversely affects functioning of an
organism.
Circumstances of Exposure can be intentional,
accidental, environmental, medicinal or recre-
ational.
 “All substances are poisons...the right dose
separates poison from a remedy.”

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 Epidemiology
 poisoning is an important health problem in ev-
ery country of the world .
In children below 6yrs of age accounts for 50%
of all cases.
 Almost all this exposures are unintentional.
about 60% involve non drug product most
commonly cosmetics, personal care product,
cleansing substance and hydrocarbons.

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 more than 75% of pediatrics poisoning exposure
can be managed without direct medical interven-
tion.
 poisoning exposures in children 6-12yrs of age
are much less common(6%).
The common causes of poisoning are toxic gas
exposure, acetaminophen , hydrocarbon and
organophosphate .

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The routes of exposure are
• through the mouse by swallowing.
• through the skin by contact with liquids,
sprays.
• through the nose by inhalation.
• through injection.

Ingestion is the most common route (76%)

with dermal, Ophthalmic and inhalation each
occurring in about 6% of cases.
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Approach to poisoned child
ABC’s of Toxicology:
 Airway
 Breathing
 Circulation
 Drugs:
Resuscitation medications if needed
Universal antidotes.

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 Draw blood:
chemistry, coagulation, blood gases, drug levels
 Decontaminate
 Expose / Examine
 Full vitals / Foley / Monitoring
 Give specific antidotes / treatment

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 Important history points.
• What toxic agent/medications were found near the patient?
• What medications are in the home?
• What approximate amount of the “toxic” agent was ingested?
•How much was available before the ingestion?
•How much remained after the ingestion?
• When did the ingestion occur ?
• Were there any characteristic odors at the scene of the ingestion?
• Was the patient alert on discovery?
•Has the patient remained alert since the ingestion?
•How has the patient behaved since the ingestion?

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Physical examination
A focused examination include
Vital sign
Arousal levels
Eyes
Skin
Muscle tone
Reflexes
Odors
Look for toxidormes \ toxic signs.

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General management of poisoning
General approach to the poisoned patient phases;
 stabilization of the child
Laboratory assessment
Decontamination of the gastrointestinal tract, eye,
or skin.
Limit absorption; vomiting, lavag.
Administration of antidote .

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 Specific common poisoning
1.organophosphate poisoning.
Organophosphates are used as insecticides, medication,
and nerve agents.
Most exposure occur in rural areas where the farmers use
agricultural chemicals.
Symptoms include increased saliva and tear, diarrhea,
nausea, vomiting, small pupils, sweating, muscle tremors
and confusion.
The onset of symptoms is often within minutes to hours,
and it can take weeks to disappear.

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Complications of organophosphate poisoning ;
Sever brochorreah
Seizure
Neuropathy
Respiratory failure

Successful Recovery from organophosphate poison-

ing is based on time from ingestion to initial presen-
tation, rapid stabilization and definitive manage-
ment.

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Cholinergic Symptoms

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 Nicotinic Symptoms
 Mydriasis
Tachypnea
Weakness
Tachycardia
Pediatric patients tend to present with a pre-
dominance of nicotinic symptoms!!!

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Treatment
It includes resuscitation of the patient and
give oxygen, a muscarinic antagonist [at-
ropine], fluids, and acetylecholinestrase reac-
tivator.
Atropine 0.02 mg / Kg IV. Repeat as needed
and titrate to respiratory secretions. It will
likely take massive doses!!

Pralidoxime (2-Pam) 20-40 mg / Kg bolus fol-

lowed by 10-20 mg / Kg /hour infusion.

Remember to send RBC and Plasma 21

Cholinesterase levels upon arrival and daily.
 2. Hydrocarbon poisoning[ kerosene ]
Ingestion of hydrocarbon is a common cause of
childhood poisoning in low and middle income
countries.
Kerosene is the most ingested hydrocarbon.
 exploratory behavior of the child along with im-
proper domestic storage are cause for kerosene
poisoning.
It causes respiratory distress and chemical
pneumonitis after ingestion as a result of pul-
monary aspiration.
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Ingestion of kerosene or acute exposure to vapor
lead to general signs of intoxication such as CNS
symptoms ;dizziness, nausea and head ache; cough,
choke and vomiting.
Aspiration pneumonitis is the most common mani-
festation of kerosene ingestion due to its low viscos-
ity, high volatility and low surface tension.
 the first aid of kerosene poisoning include immedi-
ate removal of the child from the source of poison-
ing and ensure the air way is open ,remove contam-
inated clothing and thoroughly wash the skin with
soap and water.
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
3. Acetaminophen Poisoning
Acetaminophen toxicity can results from ei-
ther an acute overdose or from chronic
overuse.
 It is common primarily because the medica-
tion is readily available.
 There are four stages; to describe the pro-
gression
 Stage I preclinical phase [0-24 hours]

 Early symptoms
 Mild
 Serum acetaminophen level 4 hrs. post ingestion
 PLOT ON SPECIFIC NOMOGRAM.
 No need to repeat levels
 If > 900 µmol/L ---> POSSIBLE RISK
 Nausea, vomiting, malaise and diaphoresis.
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 Normal bilirubin Transaminases and PT
 Stage I preclinical phase [0-24 hours]
 Early symptoms
 Mild
 Serum acetaminophen level 4 hrs. post
ingestion
 PLOT ON SPECIFIC NOMOGRAM.
 No need to repeat levels
 If > 900 µmol/L ---> POSSIBLE RISK
 Nausea, vomiting, malaise and diaphoresis.
 Normal bilirubin Transaminases and PT

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Stage II hepatic injury

24-48 hrs. after ingestion.

Better, less symptoms.
Elevated bilirubin, transaminases and PT

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Acetaminophen………
Stage III
48-96 hrs ( 2- 4 days) after ingestion:
Hepatic dysfunction
(Rarely hepatic failure)
Peak elevations in:
Bilirubin
Transaminases may reach > 1000 IU/L
Prolonged PT

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Acetaminophen…….

Stage IV
168- 192 hrs (7-8 days)
Clinical improvement
LFTs returning to normal

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Acetaminophen……
Probable toxicity should be treated with:
 N-acetylcysteine bolus 140 mg/kg
 Then 70 mg/kg Q 4 hrs for 17 doses.
 Assess hepatic function:
 On presentation
 Daily
 Continue other support

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 4.Toxic gases [ co ]
Among the most known toxic gases are carbon
monoxide , nitrogen dioxide, chlorine and phosgene.
Carbon monoxide poisoning is an illness that oc-
curs from breathing in co gas.
Co is colorless, odorless gas made when fuel burns.
fuel include wood, gasoline, coal natural gas and
kerosene.
Co fumes prevents the body from using oxygen
normally. And this can harm the brain , heart and
other organ.
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A child is more at a risk for co poisoning if he or she
live in a house with an appliance powered by oil ,
wood ,gas, or coal .
Children are vulnerable to CO poisoning because of
their increased metabolic demand and their inability
to vocalize symptoms or recognize dangerous expo-
sure
New born infants are more vulnerable because of
the persistence of fetal hemoglobin
.

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 Symptoms of co poisoning
Head ache
Dizziness
Weakness or clumsiness
Confusion
Chest pain
Loss of consciousness or coma
Fast or irregular heart beat
Shortness of breath
Blurry vision
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seizures
The possible complication of co poisoning are;
A child may have long lasting damage to the brain de-
pends on amount of exposure.
Severe co poisoning can cause nervous system symp-
toms days or weeks later this is known as delayed neu-
rologic syndrome.
In some cause co poisoning can lead to death.

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Treatment:
Oxygen therapy is the main treatment for
carbon monoxide poisoning.
Do not induce vomiting
Do not attempt gastric lavage
Risk of aspiration outweighs any benefit
from removal of substance
CXR around 2-4 hrs “not before 2hrs”
Observe in ER for 6-8 hrs if no symptoms
 discharge.

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Risk factors
 Young children are particularly susceptible poisoning b/c they
put most objects in their mouths and are unaware of conse-
quences.
 boys have higher rates of poisoning than girls because of dif-
ference in socialization.
 poor maternal education,
inadequate supervision of children,
substance abuse are risk factors that increase the incidence of
poisoning in children.

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Prevention
 Poisoning prevention demonstrates the effectiveness of
passive strategies, including the use of child-resistant
packaging and limited doses per container.
 Difficulty using child-resistant containers by adults is
an important cause of poisoning in young children to-
day.
 Almost 20% of ingestions occur from drugs belonging
to their grandparent who often put their medications
in pill organizers that are not childproof.
 Do not store medications, cleaning products or chemi-
cals near food it can be confusing to a hungry child
looking for food.
 When encouraging children to take medicine do not
refer to as sweet
 Keep the house with good ventilation. 36
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Thank You

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