POISONING MANAGEMENT

Dr Nandini Mannadath
Assistant Professor
College of Health & Sports Sciences
University of Bahrain-Salmania Campus
Manama, Kingdom of Bahrain
 OVERVIEW

1. Approach to suspected poisoning

2. Basic Principles in management

3. Do’s & Don’t

 INTRODUCTION:
• A poison is a chemical that harms the body.

• Poisonings can be accidental, occupational, or intentional.

• Natural or manufactured toxins can be ingested, inhaled,

injected, splashed in the eyes, or absorbed through the skin.

• Poisoning is the fourth most common cause of accidents in

children.
 What is a poison?

•A poison is a substance which, if taken into the body in sufficient

quantity, may cause temporary or permanent damage.

•Definition of Poison:
A poison is an agent of injury to humans usually by chemical reaction,
when a sufficient quantity is absorbed through epithelial lining such as
skin or gut.

•Once in the body, poisons may work their way into the blood-stream
and be carried to the tissues around the body.
 POISON/TOXIN
• Circumstances of Exposure can be intentional, accidental,
environmental, medicinal or recreational.

• Routes of exposure can be ingestion, injection, inhalation or cutaneous

absorption

• Signs and symptoms vary depending on the poison and its method of
entry.

• Vomiting is common in many cases and carries the additional danger of

the casualty inhaling his/her own vomit and choking.
 Poisoning Facts in Children
• A child is poisoned every 30 minutes in the U.S.
• 60% of all poisonings in kids less than 6 years old
• In 2000:
– over 1.1 million unintentional poisonings in kids less than 5 years old
– 26 kids less 12 years old died; 20 less than 6 years old

• In children less than 5 years old, more than 50% of all poisonings came
from non-pharmaceutical products

• Immediately calling a poison control center may decrease the likelihood

of severe poisoning
• Unintentional poisoning common in 12-36 months
• Older children and adolescents may present with
intentional poisoning
• Most children take 1-2 tablets
• Toddlers even 1 or 2 tablets of certain drugs may be
lethal
• Accidental poisoning is an important cause of morbidity and mortality in
childhood all over the world

• Such mishaps are usually unintentional in children below 5 years with a

peak occurrence around 18 months to 3 years due to
– exploratory behaviour,
- inability to discriminate safe versus unsafe agents
– careless household storage of medicines and
– toxic substances like kerosene stored in water containers.
 Epidemiology
• 0.64-11.6% of pediatric admissions and 0.6% of all pediatric deaths.
• 79% of these involve children younger than age six.
• 80% household products,21.8% drugs, agriculture pesticide 9.1%,
industrial chemicals 7%, bites and stiings 3.2% of pediatric
exposures.80% of ingestions by children under 6 are unintentional.
• Approximately 40% of ingestions reported to the poison center by
adolescents are intentional.
• Approximately 56% of adolescent ingestions are by females.
• Mortality : Death is increasingly rare due to more effective management &
preventive measures.
 0-6 Years

• Occurs primarily due to exploratory nature of children in this age

group, with only 2% mortality rate.

• Most can be managed without direct medical intervention either

because the product involved is not inherently toxic or the quantity of
the material involved is not sufficient to produce clinically relevant
toxic effects.

• However, several substances are potentially highly toxic to toddlers in

small doses.
 6-12 Years
• A second peak in pediatric exposures occurs in adolescence,
involving only 6% of reported pediatric toxic exposures.

• Exposures in the adolescent age group are primarily

intentional ( suicide or abuse/misuse of substances) and this
result in more severe toxicity.

• OTC, prescription medications and even household products

(inhalants) are common sources of adolescent exposures.
 Clinico-Epidemiological Profile Of Poisoning In Children Under
8 Years Of Age, At Rural Medical College In West Bengal
Abstract:

Acute poisoning and toxin exposure has become one of the most common cause of acute
medical illness in many countries. Clinico-epidemiological profile of poisoning in children in a
rural medical college in pediatric emergency department of a tertiary care hospital in Bankura,
West Bengal from 1st July 2012 to 30th June 2013 was studied. 89 cases of accidental
poisoning reported during the period representing 1% of all pediatric admissions. No case of
homicidal poisoning was reported. 62 (69.66%) cases were in children between 1-3 years with
male predominance. Overall mortality was 6.67%. 8.89% cases needed pediatric intensive
care support. Organophosphorus poisoning remained the commonest accidental poisoning,
followed by hydrocarbon and snake bite.
 Risk Factors for Poisoning
Unsupervised home setting /Males less than 5 years old
African American race /Lower level of education
Substance abuse / Illegal drugs.
Depressed adolescents /Adolescent females
Overdosing on medicine or using medicine that doesn't belong to you.
Being bitten or stung by venomous animals.
 Swallowing or sniffing paints.
 Coming in contact with poisonous chemicals/ Touching poisonous plants.
 Inhaling poisonous gases such as carbon monoxide, or fumes from strong
cleaning products.
 Pesticides / Household cleaning products.
 Petrochemical products e.g vaseline.
 Examples of household poisons
• Cleaning Products
• Pesticides

• Craft supplies (Paint, Glue etc)

• Cosmetics
 Examples of household poisons

• Tablets (Eg: Pain killers) • Liquid Medicines (Cough Medicine etc)

• Prescription Tablets • Medical Creams

The pill, antibiotics etc ●Vitamins
 Examples of household poisons
• Toothpaste • Alcohol

• Plants
• Food

• Animals & Pets

• Cigerattes & Nicotine
Routes of administration of poison
 Title: Changing Trends of Accidental Poisoning in Children
over the Last Two Decades
Journal :Indian Journal of Community Med. 2021 Apr-Jun; 46(2): 350–351.
Published online 2021 May 29.
Substance 1999-2003 (n=1303), n (%) 2015-2019 (n=303), n (%)
Kerosene 609 (46.6) 20 (6.6)
Drugs 226 (17.3) 179 (59.1)
Seeds and plants 64 (4.9) 4 (1.3)
Rat poison 47 (3.6) 33 (10.9)
Detergents/corrosives 41 (3.1) 12 (4)
Mosquito repellent 15 (1.1) 7 (2.3)
Insecticides 36 (2.8) 10 (3.3)
Indigenous medicines 44 (3.4) 2 (0.7)
Vinegar 28 (2.1) 2 (0.7)
Organophosphorus pesticides 34 (2.6) 11 (3.6)
Unknown 56 (4.3) 9 (3)
Others** 107 (8.1) 14 (4.6)
 Circumstances of poisoning:

1-Commonly accidental especially in the under-5 age

group.
2- Homicidal.
3-Suicidal (in older children)
 TYPES OF POISONING
➡ INTENTIONAL POISONING:-
A person taking or giving a substance with the intention of causing harm e.g suicide and assault.

➡ UNINTENTIONAL POISONING:-
If the person taking or giving a substance did not mean to cause harm, e.g For recreation such as in
an overdose or accidentally taken by toddler.

➡ UNDETERMINED:-
When the distinction between intentional and unintentional is unclear.

➡ ACUTE EXPOSURE:-
Is a single contact that lasts for seconds, minutes or hours, or several exposures over about day or
less.

➡ CHRONIC EXPOSURE:-
Is contact that lasts for many days, months or years.
 Toxidromes of Common Pediatric Poisonings
Toxin Signs or symptoms
Anticholenergics (atropine, scopolamine, Fever, flushed, warm, dry skin, dry mouth, mydriasis, tachycardia,
TCAs, antihistamines, mushrooms) arrhythmias, agitation, hallucinations, coma
Cholenergics (organophosph ates and Salivation, lacrimation, sweating, bronchorrhea, emesis, diarrhea,
carbamate insecticides) miosis, bradycardia, bronchospasm with wheezing, confusion,
weakness, fasciculations, coma
Opiates Hypothermia, hypoventilation, hypotension, bradycardia, miosis, coma

Narcotic withdrawal Nausea, vomiting, diarrhea, abdominal pain, lacrimation, diaphoresis,

mydriasis, tremor, irritability, delirium, seizure
Salicylates Fever, hyperpnea, vomiting, tinnitus, acidosis, seizure, lethargy, coma

Iron Hyperglycemia, shock, hemorrhagic diarrhea

Sympathomimetics (amphetamines, Tachycardia, arrhythmias, psychosis, hallucinations, nausea, vomiting,
phenylpropanolamie , ephedrine, caffeine, abdominal pain
cocaine, aminophylline)
Targeted History

• If witnessed – 4 “w” s • If unwitnessed - WOOD

•Who – age, weight

•What poison – name, •Where
concentration, amount •Odour
•When – time of exposure •Other victims
•Why – accidental/intentional •Drugs in proximity
•How much
Clinical profile of poisoning due to various poisons in children of age 0–12 years

• Complaints at the time of presentation

Presenting complaints Number of cases Percentage

Diarrhea 2 1.3%
Altered Sensorium 12 7.8%
Fever 6 3.9%
Cough 16 10.5%
Excessive Secretions from Mouth 37 24.2%
Asymptomatic 75 49%
Vomiting with Blood Tinge 12 7.8%

Vomiting Without Blood Stain 31 20.3%

 SEVERITY AND REVERSEBILITY:
It depends on the
◆ Concentration (dose)/ amount of poison ingested
◆ Contact time
◆ The potency/ nature of the chemical
◆ Type and condition of the exposed surface
◆ The age of the child
◆ The nutritional status of the child.
◆ Functional reserve of the individual / affected tissue
◆ Presence of secondary complications
◆ Coexisting illness
◆ The state of the stomach whether empty or full of food
 TOXIC SUBSTANCES HAVE SEVEN COMMON MAJOR
PATHOPHYSIOLOGICAL MECHANISMS THAT MAY PRODUCE
SYMPTOMS:

• Interfere with the transport or tissue utilization of oxygen. e.g

CO.
• Depress or stimulate CNS.
• Affect autonomic nervous system e.g. organophosphate.
• Affect the lungs by aspiration e.g hydrocarbon.
• Affect the heart and vasculature myocardial dysfunction e.g
antidepressant.
• Produce local damage e.g. corrosives.
• Affect on the liver e.g acetaminophen.
 First Aid with Poisons

• Swallowed poisons – do not attempt to induce vomiting, as this

may harm the casualty further.

• Inhaled poisons – remove the casualty from danger and into the
fresh air. Do not endanger yourself.

• Absorbed poisons – flush away any residual chemical on the skin.

• Obtain appropriate medical assistance.

GENERAL MANAGEMENT OF POISONING
MANAGEMENT
 STABILIZATION
• AIRWAY • BREATHING

• CIRCULATION • DEPRESSION OF CNS

 AIRWAY AND BREATHING

Majorly it is characterised by
➤ Cyanosis
➤ Retraction of intercostal muscles and substernal muscles
➤ Sweating
In severe cases
➤ Ventillation: artificial breathing
Some drugs causes asthma
NSAIDS
Antibiotics
MANAGEMENT:

• In case of Respiratory Insufficiency:

Remove clothes
Place laterally, lift chin, open the mouth gently.
Incase of airway obstruction:
• Ventilation
• Oxygen mask should be provided.
CIRCULATORY FAILURE :

• Some of the drugs may lead to circulatory failure which

may cause changes in blood Pressure, heart rate and
causes cardiac arrhythmias
• Alpha-blockers
• Beta blockers
• Cardiac glycosides
MANAGEMENT:

• Incase of circulatory failure:

• Correct acidosis
• Raise the foot bed for better circulation of blood to the brain
• Hemodynamic changes are also observed.
• Incase of heart failure:
• Correction of hypoxia, acidosis, electrolyte disorder.
• Monitoring of ECG
• Incase of "Monomorphic Ventricular Tachycardia”
– Lignocaine
– Amiodarone
– Sotolol should be given
DEPRESSION OF CNS :
• May cause "Hysteric or psychogenic coma"
• It is the condition in which the person pretending as he is in coma.
 MANAGEMENT
• It is the condition where the toxic substance is known or unknown
"coma cocktail" is given.
• "coma cocktail" is a mixture of
 EVALUATION OF TOXICITY

• It is done depending upon various factors like

– Whether it is Acute or Chronic
– Amount of dose taken
– Time factor
– If the person is in conscious or able to talk, the systemic
evaluation is done.
 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?

 Important History Points

• 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?
• Does the patient have a history of substance abuse?
 MANAGEMENT:
• IN CASE OF HYPOTHERMIA:
– Hypothermia can be caused by over usage of
 Alcohol
 Anti depressant
Benzodiazepines etc.
TREATMENT:
• Body temperature should be checked for every 30mints using thermometer
• Correction of acidosis, hypokalemia, hypotension etc should be done
• Warm water bath is used.
IN CASE OF ACID-BASE DISORDERS:

• It is based on pH, electrolyte level etc

• If pH is more than 7.4 it leads to metabolic/respiratory
alkaloses
• If anion gap is more than 20 mmol/l it leads to metabolic
disorder
• Conditions such as
Encephalopathy
Diuretics administration
Steroids administration cause Acid base disorder.
 DECONTAMINATION

• IN CASE OF EYE:
✓ Irrigate coupiously the exposed area with cold water for 15-20
min
✓ Do not use acid or alkali irrigating solution
• IN CASE OF SKIN
✓Cutaneous absorption is commonly seen of the following
substances when they were exposed occupationally/industrially
→ Phenol
→Phosphorous
→ Pesticides etc
GI TRACT DECONTAMINATION
 EMESIS
• Syrup of Ipecac/Ipecacauna was used in which it is derived from
Cephalia ipecacauna
• INDICATIONS: Alert, Consiousness, and should be given after 4-
6hrs after consumption.
• MODE OF ACTION:
Activation of peripheral receptors of GIT.

Activation of CTZ and vomiting center

– DOSE: 30ml for adult, 15ml for children
Apomorphin Obsolete emetics
Warm saline, mustard water
GASTRIC LAVAGE (STOMACH WASH)

✓ Ewalds tube is used in this process in order to clean out the contents of the
stomach.
✓ In which it is marked 50cm in adults, and 25cm in child
✓ It is often done following the ingestion of a dangerous substance, overdose
on a drug such as alcohol or before surgery
✓ Gastric lavage is indicated to empty the stomach immediately within 1-2
hours after an orally ingested overdose or poisoning
✓ Should be considered where there is evidence or risk of significant.

DOSE: 200-300ml in adults 10-15ml in children

 CATHARSIS (laxative)

“RYLES TUBE” is used in this process in which it is inserted into intestine"

■ Two types of solutions are used.

IONIC/SALINE SOLUTION SACCHARIDES

• SORBITOL
• MAGNESIUM CITRATE (4ml/kg)
• MAGNESIUM SULPHATE
(30 gm adult, 250 mg-child)
• SODIUM SULPHATE

CONTRAINDICATIONS:
 Coma
 Bowel obstruction
 Convulsions
 ACTIVATED CHARCOAL

 Fine, odourless, black, tasteless, powder

 Small size with large surface area
 Adsorption on to the surface and prevent adsorption of poison.
 DOSE: 50-100gm in adult & 10-40gm in child
 It is mixed 4-8 times with water and the slurry/suspension is
administerd

CONTRAINDICATIONS:
• Constipation
• Respiratory failure
• Vomiting
 WHOLE BOWEL IRRIGATION (WBI)
■ INDICATION:
Ingestion of large amount of Poisons that are not well bound to activated
charchoal, Sustained release medications.
■ TECHNIQUE:
Administration of 'Polyethylene glycol Electrolyte solution (PEG-ES) via
nasogastric tube.
■ DOSE:
20 to 40mL/kg per hour until the rectal effluent is clear, which takes 4-6hrs.
■ CONTRAINDICATIONS:
 Intestinal obstruction
 Perforation
 Significant GI bleeding Persistent vomiting
 ELIMINATION
METHODS FOR ENHANCING ELIMINATION OF TOXINS
• FORCED ALKALINE DIURESIS:
Defined as "phenomenon of increasing urine formation,using
diuretics and fluid, that can enhance excretion of drugs, their
overdose, and treat poisoning."
• It is used to eliminate Barbiturates, Salicylates, Lithium etc.
500ml dextrose - 5%
500ml Sodium carbonate - 12-13% 1500ml IV for first
hour
• It is most widely used process
 EXTRACORPORIAL TECHNIQUES:

HAEMODIALYSIS
• It mainly depends on 3 components
 Blood delivery system
 Dialyser
 Method and composition of dialysate of delivery

• Drugs removed through this process:

 Alcohol, Antibiotic, Heavy metals, Boric acid,
Quinine, Quinidine,Salicylates,
Benzodiazepines iodides etc are removed.

• Catheter was introduced into Femoral vein

 HAEMOPERFUSION
• Removing the drugs by passing the
blood from patient through an
adsorbent material and back to the
patient.

• Molecules which have greater affinity

for the materials, will be removed.

• Drugs removed through this process

are: Barbiturates, Organophosphates,
Digoxin etc.
 PERITONEAL DIALYSIS
• Removal of fluid and waste products
via a dialysis catheter located in the
peritoneal cavity: space between the
stomach, liver, spleen, intestines and
kidneys by
1) Diffusion
2) Osmosis
3) Ultrafiltration
4) Convection
• 10-25% effective than haemodialysis.
HAEMOFILTRATION
• Blood is injected through haemofilters and filtration occur
and eliminates high molecular weight substances i.e. is
around 4000-40000
HAEMODIAFILTRATION
• Combination of Haemodialysis and Haemofiltration
• It is rarely used
PLASMAPHERESIS
• Removal of cellular components of blood
Resuspended on to colloids, albumin, plasma
proteins reinfused
• Complete removal of toxins
• Drawback: Patient plasma proteins are
decreased.

PLASMA PERFUSION: Combination of

haemoperfusion and Plasmapheresis.

CARDIOPULMONARYBYPASS: Used rarely for

removal of Cardiac glycosides, Verapamil,
Lidocaine etc.
 ANTIDOTES

Used 5-10% because of less

available.
According to WHO “Antidote is
defined as a therapeutic
substance used to counteract
the toxic actions of a specific
xenobiotic”
Antidotes are of four types:
PHYSICAL ANTIDOTE

Agents use to interfere with poison through physical properties,not

change their nature.
✓ Prevents the absorption of the poisonous substance in body
Examples: Demulscents of fats, oils, egg albumin.

Banana Glass poisoning

Activated Charcoal Alkaloid poisoning
CHEMICAL ANTIDOTE

They Counteract the action of poison by forming harmless

or insoluble compounds by Oxidizing poisons.
Examples:
Common Salt: Decomposes Silver Nitrate by direct chemical
action.
Albumen: Precipitates Mercuric Chloride.
 PHYSIOLOGICAL ANTIDOTE

These agents have action directly opposite to that of poison

Chelating agents

Unionized Cyclic complex with cations

CHELATE

EXAMPLES OF CHELATING AGENTS :

BAL(British Anti Lewisite) /Dimercaprol ; EDTA ;PENCILLAMINE; DESFERRIOXAMINE
UNIVERSAL ANTIDOTE

• It is used in case of unknown poisoning in the body.

• It consists of
Magnesium oxide: 1part
Activated charcoal: 2parts
Tannic acid: 1part

From the above composition take 1 tablespoon in 200ml water

and given regularly.
 NURSING PROCESS

➤ Assessment
➤ Subjective/Objective/Psychological
➤ Differential Nursing Diagnosis
➤ Planning and Interventions
➤ Evaluation and Organic Monitoring
➤ Documentation.
Pupil changes associated with some toxins
and drugs
• Miosis (COPS)
• Mydriasis (AAAS)
 Miosis (COPS)

•C — Cholinergics, Clonidine

• O— Opiates, organophosphates

• P— Phenothiazines, Pilocarpine,Pontine bleed

• S— Sedative-hypnotics
 Mydriasis (AAAS)

• A— Antihistamines
• A— Antidepressants
• A— Anticholinergics, atropine
• S— Sympathomimetics (Cocaine, amphetamines)
 Laboratory Evaluation
• No toxic panel is uniformly helpful.
• If cardiac rhythm disturbances are present obtain a 12 lead ECG,
• X-ray chest for aspiration pneumonia and pulmonary edema,
• serum electrolytes,
• ABG estimations may provide valuable information.
• Certain medications may be seen on abdominal radiographs
 PARACETAMOL POISONING IN CHILDREN

Toxicity due to metabolite: N-acetyl-p-benzoquinoneimine

(NAPQI), Depletion of glutathione in the liver
Toxic dose: >200 mg/kg
Stage 1: 12-24hr- asymptomatic, nausea & vomiting
Stage 2: 24-48 hrs-elevated transaminases
Stage 3: 3-5 days-multi organ dysfunction
Stage 4: 4-14 days-recovery
Treatment: Gastric lavage, after 4 hrs and within 24 hrs
King's College criteria: liver transplantation
Case scenario
• This child suspected of
consuming 10 tablets Shock, Black stools, Raised liver enzymes,
available at home Hyperglycemia< Metabolic acidosis, DD

• Drowsy, Black stools

If seizures: INH
• SGOT – 442, SGPT – 300 Bleeding and Raised Transaminases
after 24-48 hrs

• Hhyperglycemia, Metabolic
acidosis, PT prolonged
 GI Bleed after Toxin Ingestion

IRON PARACETAMOL
Black stools in the first 24 hrs GI bleed later after 24-48 hrs

Shock, Hyperglycemia and Unusual

acidosis present

Rodenticide
On 3-4th day after consumption
 Kerosene poisoning

• Aliphatic hydrocarbon
• Most common ingested poison in Indian children

Inappropriate storage Easy accessibility

Low viscosity Displaces the alveolar gas and CNS

depression Deep penetration into tracheo bronchial tree

Low surface tension Enhance spreading on lung

High volatility Displaces the alveolar gas and CNS depression

 Admission criteria

Significant respiratory symptoms- immediate admission

Normal or mildly abnormal CXR who become
symptomatic in observation period
Mild symptoms and normal CXR who fail to improve
during observation period
CNS depression,severe GI symptoms, ingested
significant amount
 MANAGEMENT

Mild to moderate symptoms

✓ Keep NPO ;Supplemental oxygen ;Get CXR
Aymptomatic
✓ Keep NPO ;CXR at 4-6 hrs or sooner if become symptomatic
Decontamination
✓ Ipecac induced emesis and gastric lavage - NOT RECOMENDED*
✓ Risk of aspiration outweigh benefit
• Activated Charcoal: NOT RECOMMENDED
✓ Increases risk of spontaneous vomiting and additional aspiration & Does not bind well to
hydrocarbons
 Pulmonary management

Mainly supportive
 Supplemental oxygen and close monitoring
Selective Beta 2 agonist for bronchospasm
Epinephrine avoided- can cause fatal arrythmias in
hydrocarbon sensitised myocardium
 Case study

Kerosene ingestion: 1.5 year

old, consumed kerosene
brought to ER after 2 hrs,
comatose, irregular
respiration, shock
IV fluids, inotropes,
ventillation
Died after 5 hrs
Risk factors for mortality : ALC
or seizures or ventilation
 LEAD POISONING
• Children are at increased
risk of lead exposure and
the toxic effects of lead
Why are kids at increased risk?

• Increased exposure
• Increased absorption from the GI tract
Children absorb up to 70%
Adults absorb only about 20%
Increased rates of iron deficiency
• Immature blood brain barrier
• Increased retention of absorbed lead in the body
• Children <2 yo retain -50%
• Adults retain only 1%
How much lead is too much for a child?

• Until 2012, the CDC "level of concern" was 10 μg/dL

• Term "level of concern” no longer used by CDC because
all levels are of concern and no level can be considered
"safe"
• "Level of concern" replaced by "reference value"
 Symptoms of lead poisoning in children

Loss Of Appetite Irritability

Vomiting Drowsiness
Weight Loss Clumsiness
Constipation Learning disabilities
Anemia Behavior problems
Sluggishness & Fatigue Delayed growth
Abdominal pain
Hearing loss
Seizures
Long term impact: Lead and ADHD

Approximately 1 in 5 cases of ADHD among U.S

“

children have been attributed to lead exposure”

- American Academy of Pediatrics Council on Environmental Health
Long Term Impact : Delinquency

A child with a BLL >1.5 μg/dL is

8 times as likely to develop
conduct disorder.

For every 5 μg/dL increase in

BLL at age 6, the risk of being
arrested for a violent crime as a
young adult increases by nearly
50%
Blood lead levels at which adverse effects observed in
different organ systems in children

• Developmental toxicity
has been observed at
levels of 1-2 μg/dL ; 10
μg/dL is NOT a
threshold
Case study

• 7-year-old girl with anemia

• History: Lives in Baltimore, Maryland with parents, who

say that she peels paint off the wall and digs putty out of
the window frames and eats them
• Exam: height and weight 20th percentile, otherwise
appears normal
Prevention of lead poisoning

• A lead inspection check (Peeling of paints)

• Parents should ask for lead test
• Damp mop floors, damp wipe surface, frequently wash
child’s pacifiers, hand & toy.
• Prepare meal high in iron & calcium
• Chelating agent if requires
• Siblings of children with lead in their body will also be
tested
Keeping kids safe : Educational interventions
• Introduction to poison
• Games
• Poem
“It may look pretty
It may smell good
But before taste it
I’ll ask if I should”
• Colouring activity
• Get poison prevention to children and in to their homes by distributing
materials
• Implementing child to child programme or mother to mother approach
• Teach about poison control checklist