how to manage poison in children .. general rules

2. Toxics in the Home:
1- Radon 2- Lead

3. 3- Household products 4- Indoor air
pollutants

4. introduction
• Circumstances of poisoning :
1-Commonly accidental especially in the under-5 age group .
2- homicidal. 3-suicidal (in older children)

5. mortality:
Death is increasingly rare due
to more effective management
&preventive measures.

6. How Children Differ
From Adults?
Developmental
Considerations
( each age group is more
vulnerable to specific
toxins )
Physical Considerations
( there are many age-
related changes in vital
signs.)

7. Routes of administration of the poisons
Ingestion 79%
Dermal 6.3%
Ophthalmic 5.3%
Inhalation 5.1%
Bits and Stings 3.1%
Parental 1%

8. Poisoning / Overdose
Session objectives:
Diagnose Poisoning.
Give first aid treatment.
Preserve evidence.
Manage for hospital / poison treatment center.
Transportation and admission.

9. On receiving the call for assistance, you have to
ascairtain the assumption of poisoning / over
dosage. by,
Diagnosis of poisoning
Full History and circumstances of poising
.
Personal; age, sex, occupation, habits, smoking or addiction,
troubles, previous intoxication,
Family: disease, medication,
Medical: acute or chronic disease and / or medication, allergy

10. Site of poisoning: indoor, outdoor.
Time since exposure.

11. Nature of poision: gas, food,
insecticide, drug, animal bite….
ETC.
Dose and route of
administration.
Symptoms of poisoning,
vomiting, diarrhea, colic,
drowsiness, seizures, … etc.
Any attempt for treatment,
emesis cathartic, artificial
respiration, …etc.

12. Clinical Assessment
State of consciousness
Conscious Semiconscious Unconscious
Pathological
Traumatic
Toxicological
D.D of coma

13. Clinical Assessment
Vital signs: pulse, temp, b.p., Resp.
General exam: Pupils, reflexes, oedema, rash, dehydration, smell of breath.
Exam of Clothes and body orificies.
Signs of poisoning: Vomiting, diarrhea, hallucination, convulsions, characteristic smell
(i.e., alcohol, phenol org. ph insecticide, kerosene) eschars of corrosive poisons animal –
bite mark.

14. Preservation and reports
for, toxic analysis
Sampling
•Biological: vomits, stools, blood, urine.
•Suspected poison: Food, drug, syringe.

15. Hospital Admission• When the patient shows :
Unstable vital functions.
KEROSINE POISON
Symptomatic poisoning.
Poisoning with delayed symptom (he
seems well) eg: paracetamol, tricyclic
antidepressant, iron, lomotil, Aspirin,
Naphthalene.

16. Initial
Assessment and
Management
Non specific. specific.
Kerosene. Caustic.

17. 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.

18. 1-removal of the poison .
Skin : triple wash ( water , soap ,
more water)
Eyes : saline wash.
Cavities : removed by irrigation.

19. First Aid Treatment
Decontamination:
oIf inhaled Gas remove to fresh air and artificial Rasp.
o If skin contamination:
- Wash with running water and soap.
- Remove contaminated clothes.
o If ingested poison evacuation Of GIT by giving
- emesis……….Syrup epicac
- adsorption….activated charcoal
- cathartic….Mg citrate

20. 2-Initial resuscitation and stabilization:
• it is the initial priority in treating poison
children.
A:Assess airway
patency.
B:Assess the
adequacy of
breathing .

21. Stabilization:
A air way patency: remove foreign bodies and mucous.
B Breathing, depth and patter, O2 and artificial respiration.
C Circulatory stability, I.V. access with large-bore cannula.
Elimination:
Diuresis, Forced “Alkalin or Acidic”

22. C:Assess the circulation in terms of
1-cardiovascular status .
2-effect of circulatory inadequacy to other organs

23. 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 child's
temperature.

24. 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.

25. • Mechanism and dose :
It adsorbs many toxins (except metals,
alcohols & petroleum distillates) &
reduces its absorption into the
bloodstream.
Dose : 1 g/ kg.

26. Disadvantage: It is an
odorless, tasteless, black
powder so Children may
be averse to its gritty
texture & color.
if they cannot be cajoled
with flavoring, an opaque
cup, and straw, then it
can be administered by a
nasogastric tube.

27. 2- Gastric lavage :
usually reserved for children who present
within 1 h of ingesting a potentially life-
threatening poison.

28. 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.

29. hydrocarbons

30. 3- Whole-bowel irrigation:
Irrigation is a newer
technique used to
flush the toxin through
the bowel , thereby
preventing further
absorption.

31. Polyethylene glycol
500 ml /h is given orally
& continued until the
rectal effluent is clear
(in 4-6 h).
serial abdominal
radiographs may also
be used to demonstrate
its effectiveness.

32. It is particularly useful for ingestions
that are not adsorbed by AC such as:
Lead paint
batteriesiron tablets

33. Symptomatic
Rx
hypotension
arrhythmia
convulsions
Pain
hypothermia

34. 5-elimination of the already absorbed
poisons.
Absorption of poisons occurs after six hours
after ingestion.
The techniques are :
forced diuresis.
peritoneal
dialysis
hemodialysis.
hemoperfusion. hemofiltration. plasmapheresis.
exchange
transfusion.

35. Antidote administration
Atropine: Resp stimulant, orango-ph. Insecticides.
Naloxon: Coma (eg: Opioids) as morphine, heroin,
fentanyl.

36. Symptomatic Treatment
Hyperthermia: Cold foments.
Hypothermia: Warmth.
Bleeding: Blood. Transfusion.

38. Kerosene poisoning is common
in communities where
kerosene is a major household
fuel.
The circumstance is usually
accidental ingestion (mistaken
for water)

39. Management
Investigations Treatment

40. Investigations
to aid management and to monitor
complications in other organ systems we
do:
full blood
count
electrolytes
Urea&
creatinine
level
liver function
test

41. 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

42. Perihilar opacity Bi-basal infiltration
Initially the chest radiograph may be normal but
positive findings develop over the first few hours
after ingestion of kerosene. Common findings
include perihilar opacities and bi-basal infilteration.

43. Treatment:
maintenance of airway, breathing and
circulation.
Stabilization of the airway is always the first
priority of treatment.

44. HOSPITALIZATION WITH ANTIBIOTIC
TREATMENT AS PROPHYLAXIS FOR PASPIRATION
PNEUMIA AND FEAR OF ENCEPHALOPATHY OR
OTHER ORGAN DAMAGE
Gastric lavage and induction of emesis
( e.g. use of Ipecac) should not be
considered in the management of
kerosene poisoning as these may
cause further aspiration and worsens
the condition.

46. Inorganic non metal :
–Acids as sulfuric acid and hydrochloric acid.
–Bases (alkali)as ammonia, k permanganate .
Organic non metal:
- Carbolic acid and oxalic acid.
Classification of corrosives:

47. • 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)

48. Routine investigation :Complete blood count, glucose
and electrolyte determination level.
Chest and abdominal X-ray should be taken to rule out
visceral perforation.
Ocular slit- lamp examination with topical fluorescein
dye in cornel burns.

49. No Gastric lavage
No Emesis
Not give activated charcoal
No bicarbonate or antidote

50. Assess the A –B- C
Give water (diluting) only
60 ml
Demulcent as cold milk OR egg white OR both
Analgesics and antibiotics
corticosteroids