• 90% of poisonings in children occur in the home environment and mostly with a single agent.
• Oral ingestion is the most common form of poisoning (77%); about 50% of cases are with non-pharmaceutical substances (cosmetics, personal care products, cleaning solutions, herbs, foreign bodies, hydrocarbons).
• The most commonly taken drugs are analgesics, cold and cough syrups, antibiotics and vitamins. • Death after unconscious ingestion is rare in children; The reasons for this include child-proof packaging, education of families, early detection of poisoning and treatment opportunities.
MEDICINES THAT CAN MAKE TOXICITY IN LOW DOSE IN CHILDREN
IMPORTANT INFORMATION ON POISONING
Known drug toxicity syndromes
METABOLIC ACIDOSIS (MNEMONIC = MUDPILES)
• Methanol, carbon monoxide
• Uremia
• Diabetes mellitus
• Paraldehyde, phenformin (phenformin)
• Isoniazid, iron
• Lactic acidosis (cyanide, carbon monoxide)
• Ethanol, ethylene glycol
• Salicylates, starvation, seizures
INCREASE IN OSMOLAR GAP
Alcohols: ethanol, isopropyl, methanol, ethylene glycol
Hypoglycemia (MNEMONIC = HOBBIES)
• Hypoglycemic agents (sulfonylurea, meglitinide) TUS PREPARATORY CENTERS 727 BIES)
• Other: consumption of quinine, raw tropical fruit
• Beta Blockers
• Insulin
• Ethanol
• Salicylates
HYPERGLYCEMIA
• Salicylates (early)
• Calcium channel blockers
• Caffeine
HYPOCALCEMIA
• Ethylene glycol
• Fluorid
RABDOMIOLYSIS
• Diphenhydramine, doxylamine
• Neuroleptic malignant syndrome
• Statins
• Mushrooms
• Any toxin that causes prolonged immobilization (eg opioids) or toxin that causes excessive muscle activity or seizures (eg sympathomimetics)
RADIOPAQUE SUBSTANCES (IN THE URINARY SYSTEM) (MNEMONIC = CHIPPED)
• Chloral hydrate, calcium carbonate
• Heavy metals (heavy metals (lead, zinc, barium, arsenic, lithium, bismuth)
• Iron
• Phenothiazines
• Play-Doh (play dough), potassium chloride
• Enteric coated tablets
• Dental filling
ECG Findings in Poisonings
PR EXTENSION
• Digoxin
• Lithium
QRS EXTENSION
• Tricyclic antidepressants
• Diff enhydramine
• Carbamazepine
• Cardiac glycosides
• Chloroquine, hydroxychloroquine
• cocaine
• Lamotrigine
• Quinidine, quinine, procainamide, disopyramide
• Phenothiazines
• propoxyphene
• Propranolol
• Bupropion, venlafaxine (rare)
QTc EXTENSION
• Amiodarone
• Antipsychotics (typical and atypical)
• Arsenic
• cisapride
• Citalopram and other serotonin reuptake inhibitors
• Clarithromycin, erythromycin
• Dizopyramide, dofetilide, ibutilide
• Fluconazole, ketoconazole, itraconazole
• methadone
• Pentamadine
• Phenothiazines
• Sotalol
Important antidotes in poisoning
Drugs that can form bezoars
Treatment of Poisoning
Activated carbon
• It is especially effective if given within the first hour after poisoning.
• Drugs Not Bound to Activated Charcoal
- Alcohol
- Corrosives: alkalis and acids
- lithium
- Hydrocarbons
- Cyanide
- Heavy metals
- Iron
Whole bowel irrigation
• Iron, delayed-release preparations, foreign bodies-drug packages (cocaine packages)
vomiting
• The use of Ipeca syrup is not recommended.
Dialysis
• For dialysis to be effective, the drug taken must have a low volume of distribution (< 1 L/kg), a small molecular weight, a low protein binding ratio, and a high water solubility.
• Examples of poisoning in which dialysis is effective can be given as methanol, ethylene glycol, salicylate, theophylline, bromide and lithium.
