Poisoning

Always think of ingestion in any child with sudden onset of altered level of consciousness or displaying any symptoms of the presentation listed below. Always ask what drugs/medications are available in the house and remember recreational drugs too. If the possibility of ingestion was remote, only observation is necessary. 

Note: Search all products by name on Afritox software on Paeds computers Paarl Hospital or Call Tygerberg Poison Info Centre 24hrs: (021) 931-6129 for expert help.

Clinical presentation can be divided into ‘toxidromes”:

• Cholinergic: salivation, lacrimation, urination, defecation, diarrhoea, vomiting, bronchorrhoea, bradycardia
• Salicylism: tachypnoea, metabolic acidosis, agitation, coma, seizures
• Anticholinergic: fever, ileus, flushing, tachycardia, urinary retention, dry/warm skin, blurred vision, mydriasis (dilated pupil), coma, hallucinations, seizures
• Sedative-hypnotic toxidrome: obtundation or coma, with normal vital signs
• Opiates: altered (decreased) mental status, miosis, respiratory depression, bradycardia, decreased bowel sounds, hypothermia
• Dystonic reaction: torticollis, opisthotonus, intermittent spasm tongue thrusting
• Sympathomimetic toxidrome: hypertension, tachycardia, hyperthermia, agitation, diaphoretic skin, and dilated pupils (sympathomimetic toxidrome resembles anticholinergic toxidrome)–flight and fright response
• Toxic alcohols: metabolic acidosis, increased osmolar gap, visual disturbances (methanol), renal failure (ethyleneglycol), convulsions, hypoglycaemia, depressed level of consciousness (alcohol)

General principles:

• Stabilization: ABC including GCS score, manage secretions, O2, iv line, HGT
• Decontamination: (only do decontamination if there is the risk of toxicity)
• GASTRIC LAVAGE
  • Gastric lavage is contraindicated if a corrosive substance or volatile hydrocarbon has been ingested. Gastric lavage should not be considered unless a patient has ingested a potentially life-threatening poison and the procedure can be under taken within 60 minutes of ingestion. (Gastric lavage may be contraindicated in an unconscious patient unless the airway is protected.)
• ACTIVATED CHARCOAL
  • NB the following substances are NOT absorbed by activated charcoal: All alcohols, hydrocarbons, metals (eg iron or lead), minerals (eg sodium) Dose of activated charcoal: 
    • <6years ,10gin 50-100mlwater
    • >6years,20-50gin 100-300ml water
• WHOLE BOWEL IRRIGATION
  • Large volumes of polyethelene glycol solution (indications include iron, lithium, lead, or sustained release or enteric-coated drugs). (Dose of polyethylene glycol electrolyte solution: 30ml/kg Rate in children:0.5L/hror2L/ hr for adolescents) Treatment continued until rectal effluent is clear.
• Emesis (with ipecacuanha) is now no longerrecommended and should not be used.
• Use an antidote if available.
• Call Tygerberg Poison Info Centre 24hrs: (021) 931-6129 for expert help.
• For treatment of specific substance (e.g. paracetemol charts) see back of SAMF.