Poisoning in children

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  • Poisoning in children

    1. 1. POISONINGBYDr. HAMDY ABO HAGARLecturer of Pediatrics
    2. 2. Ingestion of toxic productsby children is a commonoccurrence.Children under 5 years ofage account for 80% ofrecorded cases of poisoningestion.INCIDENCE
    3. 3. Poison Identification
    4. 4. Poison identification1. The initial history should include theidentification of the product ingested(containers or bottles should be brought).2. Physical examination will often revealsupporting evidence for a particularingestion.
    5. 5. Poison identification3. When the nature of the substanceingested is unknown, the list of commonsymptoms or signs are presented in table
    6. 6. Poison identification4. The specific substance causing apoisoning should be confirmed byqualitative analysis performed on blood orurine.Gastric fluid analysis will be of value ifdone within 2-3 hours of ingestion.
    7. 7. Poison identificationHISTORYEXAMINATIONMANIFESTATIONSANALYSIS
    8. 8. Toxidromes(Symptoms and signs of common toxic exposures)
    9. 9. ToxidromesSystem involved(CNS)Substance involvedDepression andcoma- Sedatives,- Narcotics,- Tranquilizers,-Tricyclic antidepressants,- Anticonvulsants,- Alcohol,- Hypoglycemic agents,- Hydrocarbons,- lead, mercury, lithium and CO.
    10. 10. System involved(CNS)Substance involved- Convulsions - Amphetamines,- Xanthines,- Sympathomimetics,- Psychotropics, cocaine,- Ergot,- Strychnine,- organophosphates,Toxidromes
    11. 11. System involved(CNS)Substance involved- Hallucinations Amphetamines,psychotropics,alcohol withdrawal,antihistamines,cocaine,tricyclic antidepressants.Toxidromes
    12. 12. ToxidromesSystem involved(CNS)Substance involved- Hyperpyrexia Atropine, salicylates
    13. 13. ToxidromesSystem involved(CVS)Substance involved- Arrhythmias - Digitalis,quinidine,tricyclic antidepressants,cocaine
    14. 14. ToxidromesSystem involved(CVS)Substance involved- Tachycardia -Amphetamines,-xanthines,sympathomimetics,- cocaine,-tricyclic antidepressants
    15. 15. ToxidromesSystem involved(CVS)Substance involved- Bradycardia -Beta blockers,cardioglycosides,-quinidine,-calcium-channel blockers.
    16. 16. ToxidromesSystem involved(CVS)Substance involved- Hypotension - Antihypertensive agents,tricyclic antidepressants,narcotics
    17. 17. ToxidromesSystem involved(GIT)Substance involved- Nausea,vomiting, anddiarrhea- Almost any toxic substancecan produce thesesymptoms and signs.
    18. 18. ToxidromesSystem involved(GIT)Substance involved- Increasedsalivation- Insecticides
    19. 19. ToxidromesSystem involved(GIT)Substance involved- Decreasedsalivation- Antihistaminic,antimuscarinic agents
    20. 20. ToxidromesSystem involved(Respiratory )Substance involved- Hypoventilation - CNS-depressant agents
    21. 21. ToxidromesSystem involved(Respiratory )Substance involved- Hyperventilation -Salicylates,-cocaine,-nicotine,- CO2
    22. 22. ToxidromesSystem involved(Ocular)Substance involved- Mydriasis -Atropine,sympathomimetics,psychotropics,-cocaine
    23. 23. ToxidromesSystem involved(Ocular)Substance involved- Miosis - Narcotics,- Organophosphateinsecticides,- Parasympathomimetics
    24. 24. ToxidromesSystem involved(Cutaneous)Substance involved- Cyanosis -Nitrites,-aniline dyes
    25. 25. ToxidromesSystem involved(Cutaneous)Substance involved- Jaundice -Carbon tetrachloride,benzene,-phenothiazines
    26. 26. Supportive therapy:1. Cardiopulmonary support.The ABCs items of cardiopulmonaryresuscitation are applied for poisonedchild.
    27. 27. Supportive therapy:2.  Fluid support.Replace the previous and ongoingfluid losses while correcting electrolytedisturbances.
    28. 28. Supportive therapy:3.  Hematologic support.Correction of hemolytic anemias withpacked RBCs or exchange transfusion.
    29. 29. Supportive therapy:4. CNS support.For control of seizures and prolongedcare of comatose child.
    30. 30. Supportive therapy:5. Renal support.Renal function is monitored andhemodialysis is instituted as needed.
    31. 31. Gastrointestinal decontamination:A) Gastric evacuation: It is the cornerstone of interventionafter a toxic ingestion. Its efficacy fallswhen it is instituted more than onehour after an ingestion.
    32. 32. Gastrointestinal decontamination: Ipecac syrupIs the method of choice for gastricemptying, where it induces emesiswithin 15 minutes of intake.
    33. 33. Gastrointestinal decontamination: Orogastric lavageIs as effective as ipecac and offersthe advantage of speed and theprompt administration of adsorbentand cathartic.
    34. 34. Gastrointestinal decontamination: Orogastric lavage
    35. 35. Gastrointestinal decontamination:B) Adsorbents: Activated charcoal forms a stablecomplex with the toxin, thuspreventing its absorption. It is not given before ipecac andis not effective against metals,alcohols, hydrocarbons, orcaustics. It is given in a dose of 1gm/kg inwater orally.
    36. 36. Gastrointestinal decontamination:C) Cathartics:• As magnesium citrate and sorbitol.• They hasten transit of gastrointestinalcontents, thus decreasing systemicabsorption of the toxin.
    37. 37. Elimination enhancement:1. Fluid and osmotic diuresis by intake ofhypertonic fluid.2. Diuretics,such as frusemide (2 mg/kg/dose) areused to increase urine output.
    38. 38. Elimination enhancement:     3. Ionized diuresis;excretion of acidic compounds, suchas salicylates and barbiturates, isenhanced by alkalinization of urinewhich is accomplished by IV sodiumbicarbonate.
    39. 39. Elimination enhancement:     4. Extracorporeal poison removal,such as by hemodialysis, peritonealdialysis and exchange transfusion.
    40. 40. Antidotes
    41. 41. AntidotesThe number of ingestions forwhich there is a specificantidote is small.
    42. 42. AntidotesPoison Antidote dose-Carbonmonoxide-Chlorpromazineandmetoclopromide(primpran)OxygenDiphenhydramine- 100% orhyperbaric O20.5 -1 mg/kg, IVor IM.
    43. 43. AntidotesPoison Antidote dose-Cyanide -OrganicphosphorousNa nitrite, Nathiosulphate PralidoximeAtropine- depends onhemoglobin level. 20-40 mg/kg, IVover 15-30 min0.1 mg/kg, IV every10-30 min untilpupillary dilatation.
    44. 44. AntidotesPoison Antidote dose- Opiates,narcotics - IronNaloxone(Narcan) Deferoxamine- 0.1 mg/kg, IV,may be repeatedtwice. 10–15 mg/kg/hr, (IVinfusion)
    45. 45. AntidotesPoison Antidote dose-Isoniazide-Methemoglobinemia -LeadPyridoxine(B6)Methylineblue EDTA5 gm, IV 1-2 mg/kg, IV over10 min 250 mg/M2/dose,IM, every 4 hrs.
    46. 46. How can I protect my child?The most important and practical measure is to ensure toxic substances are completely out of reach in the first place. Make a thorough check of your house and garden, removing any harmful products and placing them in a securely locked cabinet. 
    47. 47. THANK YOU

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