A 5-year-old boy ingested approximately 5 mouthfuls of shampoo 30 minutes prior to arriving at the hospital. Upon arrival, he reported slight tongue numbness but felt well otherwise with no vomiting, dyspnea, or abdominal pain. Shampoo contains surfactants like nonionic surfactants which are condensation products of fatty alcohols and ethylene oxide that can cause minor oral irritation but are generally considered low toxicity at normal usage amounts.

1. Common Toxicology sukit wipusattaya Emergency Medicine

2. Common poison exposure Ramathibodi Poison Center: 2001-2005 Ramathibodi Poison Center: 2001-2005 กลุ่ม จํานวน % สารป้องกันกำจัดศัตรูพืช (pesticides) 9,327 39.9 สารใช้ในบ้านเรือน (household products) 4,421 18.9 ยา (pharmaceutical products) 4,397 18.8 สารใช้ในงานอุตสาหกรรม (occupational products) 2,527 10.9 พืชมีพิษ (plant toxins/poisonous plants) 977 4.2 สัตว์มีพิษ (poisonous animals) 621 2.7 รวม 23,368

8. Liquefaction necrosis

19. Hydrofluoric acid

23. Pathologic severity of injury

28. Acetaminophen

29. Paracetamol Sulfation Glucuronidation CYP2E1 Renal excretion NAPQI Reduced glutathione + CYP2E1 NAPQI

32. Overdose estimation: amount > 150 mg/kg

34. Treatment Paracetamal level N-acetylcysteine

42. Suspected CNS Suppression Intoxication Anticholinergic sign Respiratory Suppress Constrict pupil dilate pupil Phenothizine TCA Benzodiazepine Opioid Barbiturate Yes Yes Yes Yes No No No No

43. Opioid

54. Inhibit acetylcholine esterase enzyme

57. Sign and Symptom Mnemonics DUMBELS D – Diarrhea U – Urination M – Miosis B – bradycardia, bronchospasm, bronchorrhea E – Emesis L – Lacrimation S – Salivation Days of the Week: M – Mydriasis T – Tachycardia W – Weakness H – Hypertension F – Fasciculations

61. Paraquat Trade name: Gramoxone Herboxone Dextron Color: Blue - green

62. Toxicodynamic Mechanism PQ 2+ PQ + NADP + NADPH O 2 . PQ reductase Pentose phosphate pathway Cell death : (lung , liver , kidney) O 2

63. Oropharyngeal ulceration and corrosion

64. Ocular injury

66. Paraquat Lung Day 1 Day 28

69. alkaline sodium dithionate Paraquat

73. Detergent Surfactant Builder

103. ยาจุดกันยุงและผลิตภัณฑ์กันยุงใชักับเครื่องไฟฟ้า

106. Respiratory mildly irritate rhinitis , bronchitis , bronchospasm , asthma Cardiovascular not direct effect Nervous type I : T-syndrome (tremor) type II : CS-syndrome ( choreoathetosis salivation seizure) skin & mucous membrane allergic contact dermatitis allergic conjunctivitis

107. Gastrointestinal salivation , N/V , abdominal pain , diarrhea Liver effected due to prolong hypoxemia Genitourinary effected due to prolong hypoxemia

108. Decontamination Respiratory Remove from source adequate ventilation with 100% oxygen inhaled beta-agonist Skin remove all contaminated clothing ,jewelry wash affected area with water and liquid detergent Eye irrigate with water at least 20 mins Morgan lenses with ophthamic local anesthetics

109. Primary survey and resuscitation Airway open airway , intubate if necessary Breathing adequate oxygenation high flow O2 15 LPM via nonrebreathing reservoir mask BMV in inadequate spontaneous ventilation endotracheal intubation Circulation cardiac monitoring , ALCL guideline start IV NSS Disability assess level of conscious continually IV diazepam if seizure despite adequate O2 and glucose Exposure undress and decontaminated

110. Poisoning treatment paradigm Alter Absorption Remove from the poison Antidote non Basic continue reassess ABC treat anaphylactic Change catabolism not applicable Enhance Elimination not applicable