introduction• Circumstances of poisoning :1-Commonly accidental especially in the under-5 age group . 2- homicidal. 3-suicidal (in older children)
mortality:Death is increasingly rare dueto more effective management&preventive measures.
How Children Differ From Adults? Developmental Physical Considerations Considerations ( there are many age-( each age group is more related changes in vital vulnerable to specific signs.) toxins )
Routes of administration of the poisons Ingestion 79% Dermal 6.3% Ophthalmic 5.3% Inhalation 5.1% Bits and Stings 3.1% Parental 1%
Initial Assessment and ManagementNon specific. specific. Kerosene. Caustic.
A-Non specific management:1- removal of the source of poison away from the child .2- initial resuscitation and stabilization.3- removal of unabsorbed poison from GIT.4-elimination of already absorbed poisons.5-symptomatic and supportive measures.
1-removal of the poison . Skin : triple wash ( water , soap , more water) Eyes : saline wash. Cavities : removed by irrigation.
2-Initial resuscitation and stabilization:• it is the initial priority in treating poison children. A:Assess airway B:Assess the patency. adequacy of breathing .
C:Assess the circulation in terms of1-cardiovascular status .2-effect of circulatory inadequacy to other organs
D:Assess neurological function in terms of: -level of consciousness -pupillary size and reaction -bedside blood glucose concentration. -presence of any seizure activity.E:Record the childs temperature.
3-removal of unabsorbed poisons• from the GIT.1- Activated charcoal (AC): it is the safest mode. It is given if the child has taken a potentially toxic overdose within the previous hour.
• Mechanism and dose : It adsorbs many toxins (except metals, alcohols & petroleum distillates) & reduces its absorbtion into the bloodstream. Dose : 1 g/ kg.
Disadvantage: It is anodorless, tasteless, blackpowder so Children maybe averse to its grittytexture & color. if they cannot be cajoledwith flavoring, an opaquecup, and straw, then itcan be administered by anasogastric tube.
2- Gastric lavage : usually reserved for children who present within 1 h of ingesting a potentially life- threatening poison.
disadvantage: It is often difficult to remove the toxic agent from the GI tract because of the small size of lavage tube needed in pediatric patients. the child will often need to be intubated to facilitate this technique.
5-elimination of the already absorbed poisons. Absorption of poisons occurs after six hours after ingestion. The techniques are : peritoneal forced diuresis. hemodialysis. dialysis hemoperfusion. hemofiltration. plasmapheresis. exchange transfusion.
Kerosene poisoning is commonin communities wherekerosene is a major householdfuel. The circumstance is usually accidental ingestion (mistaken for water)
Investigationsto aid management and to monitorcomplications in other organ systems wedo: full blood electrolytes count Urea& liver function creatinine test level
Chest x-ray is done in all symptomatic patient to :1-determine the extent of injury .2-rule out differentials which include -atelectasis -inhalation injury -Near Drowning -Pneumonia -Respiratory Distress syndrome
Initially the chest radiograph may be normal butpositive findings develop over the first few hoursafter ingestion of kerosene. Common findingsinclude perihilar opacities and bi-basal infilteration. Perihilar opacity Bi-basal infiltration
Treatment: maintenance of airway, breathing andcirculation. Stabilization of the airway is always the firstpriority of treatment.
Gastric lavage and induction of emesis( e.g. use of Ipecac) should not beconsidered in the management of kerosene poisoning as these may cause further aspiration and worsens the condition.
Classification of corrosives: Inorganic non metal : –Acids as sulfuric acid and hydrochloric acid. –Bases (alkali)as ammonia, k permenganate . Organic non metal:- Carbolic acid and oxalic acid.
• PH of saliva should be checked by PH paper.• Endoscopy is the only reliable way to establish the severity of esophageal burn. It should be performed from 12- 24 hours after ingestion. (contraindicated if there is suspecting perforation)
Routine investigation :Complete blood count, glucoseand electrolyte determination level. Chest and abdominal X-ray should be taken to rule outvisceral perforation. Ocular slit- lamp examination with topical fluoresceindye in cornel burns.
No Gastric lavageNo EmesisNot give activated charcoalNo bicarbonate or antidote
Assess the A –B- CGive water (diluting) only60 mlDemulcent as cold milkAnalgesics and antibioticscorticosteroids