for family medicine doctors, G pediatrician, medical students

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

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

4. 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 )

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

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

7. 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.

8. 1-removal of the poison .
Skin : triple wash ( water , soap
, more water)
Eyes : saline wash.
Cavities : removed by irrigation.

9. 2-Initial resuscitation and stabilization:
• it is the initial priority in treating poison
children.
A:Assess airway B:Assess the
patency. adequacy of
breathing .

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

11. 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.

12. 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.

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

14. 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.

15. 2- Gastric lavage :
usually reserved for children who present
within 1 h of ingesting a potentially life-
threatening poison.

16. 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.

17. hydrocarbons

18. 3- Whole-bowel irrigation:
Irrigation is a newer
technique used to
flush the toxin through
the bowel , thereby
preventing further
absorption.

19. 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.

20. It is particularly useful for ingestions
that are not adsorbed by AC such as:
Lead paint
iron tablets batteries

21. hypotension
Symptomatic arrhythmia
Rx
convulsions
hypothermia
Pain

22. 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.

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

25. Management
Investigations Treatment

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

27. 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

28. 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.
Perihilar opacity Bi-basal infiltration

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

30. 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.

32. 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.

33. • 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)

34. 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.

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

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