poisoning in children

1. https://www.yenepoya.edu.in
Yenepoya Nursing College
18-10-2021 1

2. POISONING
Presented by,
Fathimath Shaharban M.H
II MSc Nursing
Dept. of Child Health
Nursing
Supervised by,
Mrs. Sharin Neetal D’souza
Assistant professor stage II
Dept. of Child Health Nursing
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3. Introduction
• 60% of poison control center calls are for patients under the age of 17
• Most pediatric ingestions are accidental and minimally toxic
• Higher morbidity in adolescent ingestions
• Many pediatric patients present with unexplained signs and symptoms
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4. Definition
Poisoning is injury or death due to swallowing,
inhaling, touching or injecting various drugs, chemicals, venoms or
gases.
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5. Risk factors
Unintentional poisoning in young children is an important public health
issue:
• 1–3 years have the highest levels of poisoning risk among children
• nature of the caregiver-child relationship and caregiver attributes
• less proximal maternal supervision during risk taking activities
• medicinal substances stored in more accessible locations in bathrooms
• parenting stress.
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6. Common agents involved in poisoning
• Kerosene
• Medicines
• Acids
• Insecticides
• Cosmetics
• Paints
• Bleach
• Bites and stings of animals
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7. Selected poisoning in children
1. Corrosive agents( strong acid/alkaline)
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Agents Clinical manifestations Treatment
• Bleach
• Denture cleaners
• Dishwasher
• Drain, toilet& oven
cleaners
• Coughing, hemoptysis
• Drooling& inability to
clear secretions
• Severe burning pain in
the nose, mouth&
stomach
• Edema of lips, swollen
mucous membrane
• Activated charcoal&
inducing emesis are
contraindicated.
• Maintain patent airway
• Administer analgesic
• Oral fluids when
tolerated
• Esophageal stricture
require repeated
dilatation.

8. Selected poisoning in children
2. Hydrocarbons
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Agents Clinical manifestations Treatment
• Gasoline
• Kerosene
• Lighter fluid
• Paint thinner
• Turpentine
• Burning throat&
stomach
• Gagging, choking,
coughing
• Nausea& vomiting
• Alteration in
sensorium
• Tachypnea,
grunting, cyanosis
• inducing emesis is
contraindicated.
• Cuffed endotracheal
tube should be in place
before lavage because
of high risk of
aspiration.

9. Selected poisoning in children
3.Aspirin
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Agents Clinical manifestations Treatment
• Aspirin • Nausea/vomiting
• Hyperventilation
• Tinnitus
• Hyperactivity
• Fever
• Confusion
• Seizure
• Renal failure
• Resp. failure
• Severe cases- bleeding
• Activated charcoal
• NaHC03- Metabolic acidosis
• External cooling- hyper
pyrexia
• Vit K – bleeding
• Anticonvulsants
• O2 administration
• Severe cases hemodialysis is
used

10. Selected poisoning in children
4.Iron
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Agents Clinical manifestations Treatment
• Mineral
supplements
or vitamin
containing
iron
• Vomiting
• Hematemesis
• diarrhea
• Abdominal pain
• Hyperglycemia
• seizure
• Shock
• Jaundice
• Pyloric stenosis secondary
to scarring
• Bowel irrigation
• Induce emesis
• Activated charcoal
does not absorb iron
• Chelation therapy with
deferoxamine- severe
cases

11. Selected poisoning in children
5.plants
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Agents Clinical manifestations Treatment
• Depends upon type
of plant
• Local irritation
• Renal, respiratory,
CNS symptoms
• Wash from skin or eyes
• Provide supportive care
as needed

12. MANAGEMENT
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13. Non specific poisoning Management
1-Removal of the poison .
1. Skin : Remove the child’s clothes and rinse the skin with lukewarm
water for at least 15 minutes.
• triple wash ( water , soap , more water)
2. Eyes : saline wash.
3. Cavities : removed by irrigation.
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14. Non specific poisoning Management cont
2-Initial resuscitation and stabilization:
• it is the initial priority in treating poison children.
A:Assess airway
B:Assess the patency ;adequacy of breathing .
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15. Non specific poisoning Management cont
C:Assess the circulation in terms of
• cardiovascular status .
• effect of circulatory inadequacy to other organs
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16. Non specific poisoning Management cont
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.
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17. Non specific poisoning Management cont
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 absorption into the bloodstream.
Dose : 1 g/ kg.
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18. Non specific poisoning Management cont
Disadvantage:
• It is an odorless, tasteless, black powder so children may be averse to
its gritty texture & color.
• If they resisting with flavoring, an opaque cup and straw can be used
or then it can be administered by a nasogastric tube.
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19. Non specific poisoning Management cont
2- Gastric lavage :
• usually reserved for children who present within 1 h of ingesting of 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.
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20. Non specific poisoning Management cont
Contraindications for lavage
• Alkali
• Hydrocarbons
• Acids
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21. Non specific poisoning Management cont
3. Whole-bowel irrigation:
• Irrigation is a newer technique used to flush the toxin through
the bowel , thereby preventing further absorption.
• serial abdominal radiographs may also be used to
demonstrate its effectiveness.
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22. Non specific poisoning Management cont
3. Whole-bowel irrigation:
Golytely® (PEG-ELS)
• combination of electrolytes and polyethylene glycol (PEG)
• 0.5 L/hr for small children and 2 L/hr for adolescents and
Adults
• administer for 4 - 6 hours or until rectal effluent is clear
• useful for ingestions of iron, lithium, and sustained release preparations
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23. Non specific poisoning Management cont
4. Elimination of the already absorbed poisons:
Absorption of poisons occurs after six hours after ingestion.
The techniques are :
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Forced
diuresis
hemodialysis
Peritoneal
dialysis
Plasmapheres
is
Exchange
transfusion
hemofiltration
hemoperfusio
n

24. Specific poisoning Management
Kerosene poisoning is common in communities where kerosene is a
major household fuel. The circumstance is usually accidental ingestion
(mistaken for water)
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25. Kerosene
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Investigations
1.PH of saliva should be checked by PH paper.
2.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, glucose and electrolyte 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.

26. Treatment- kerosene
No Gastric lavage
Not to induce Emesis
Not to give activated charcoal
No bicarbonate or antidote
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27. Treatment- kerosene
• Assess the A –B- C
• Give water (diluting) only 60 ml
• cold milk as Demulcent
• Analgesics and antibiotics
• corticosteroids
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28. Prevention
• Education is the major component of any poison prevention programme.
• Keep medicines, insecticides, etc. out of the reach and sight of children.
• Never store food & cleaning products
together.
• Store medicine and chemicals in original
containers.
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29. Risk factors for unintentional poisoning in children aged 1–3
years in NSW Australia: a case–control study
Four groups of children, one case group (children who had experienced a
poisoning event) and three control groups (children who had been
‘injured’, ‘sick’ or who were ‘healthy’), and their mothers (mother-child
dyads) were enrolled into a case–control study. All mother-child dyads
participated in a 1.5-hour child developmental screening and
observation, with mothers responding to a series of questionnaires at
home.
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30. Risk factors for unintentional poisoning in children aged
1–3 years in NSW Australia: a case–control study
Results
Five risk factors were included in the final multivariate models for one or more case–
control pairs. All three models found that children whose mothers used more positive
control in their interactions during a structured task had higher odds of poisoning.
Two models showed that maternal psychiatric distress increased poisoning risk
(poisoning-injury and poisoning-healthy). Individual models identified the following
variables as risk factors: less proximal maternal supervision during risk taking
activities (poisoning-injury), medicinal substances stored in more accessible locations
in bathrooms (poisoning-sick) and lower total parenting stress (poisoning-healthy).
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31. Summary
Till now we discussed about poisoning; it’s definition, Risk factors,
Common agents involved in poisoning, Selected poisoning in children,
Non specific poisoning Management, Specific poisoning Management,
Prevention.
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32. 21-10-2021 32

33. Evaluation
1. Which methods are used in non specific poisoning management?
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34. Conclusion
Most poisonings occur when parents or caregivers are home but not
paying attention. The most dangerous potential poisons are medicines,
cleaning products, liquid nicotine, antifreeze, windshield wiper fluid,
pesticides, furniture polish, gasoline, kerosene and lamp oil. Be especially
vigilant when there is a change in routine. Holidays, visits to and from
grandparents’ homes, and other special events may bring greater risk of
poisoning if the usual safeguards are defeated or not in place.
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35. References
• Hockenberry, Wilson. Wong’s nursing care of infants and children. 10th edition;
elsevier publications: 2015.p 168- 169.
• Datta p. pediatric nursing. Third edition. New Delhi; Jaypee publications: 2014.p
545-546
• Gupta L.G, Gupta A. Manual of first aid. First edition. New Delhi; Jaypee
publications: 2007. p 235-246
• Schmertmann, M., Williamson, A., Black, D. et al. Risk factors for unintentional
poisoning in children aged 1–3 years in NSW Australia: a case–control study. BMC
Pediatr 13, 88 (2013). https://doi.org/10.1186/1471-2431-13-88
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