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Emergency Management of Poisoning in Children: An Overview

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Poisoning is considered one of the most everyday pediatric emergencies. For more details, read the article below.

Written by

Dr. Nancy Yadav

Medically reviewed by

Dr. Veerabhadrudu Kuncham

Published At November 9, 2022
Reviewed AtMay 23, 2023

Introduction

There is no clear definition of poisoning. Poisoning can be an injury or death due to swallowing, inhaling, touching, or injecting drugs, chemicals, venoms, or gasses. In children, acute poisoning is caused by household products because of their easy availability and attractiveness potential.

What Is Poisoning in Children?

Pediatric poisoning is a widespread emergency around the globe. One to five years of age constitute 80 % of poisoning cases. Surveillance is needed for public health authorities and physicians to update strategies for the prevention and management of pediatric poisoning.

In the early phase of life, the overdose of medication by parents turns out to be the leading cause of poisoning in a child. At two to three years of age, most cases of poisoning are because of house cleaning products. At three to five years of age, the medications left open become the leading causes of poisoning, and at school age and during adolescence, drugs or substances used for committing suicide results in case of poisoning.

When to Suspect Poisoning in Children?

Poisoning signs and symptoms can mock other conditions, like seizures, alcohol intoxication, and stroke. Signs and symptoms of poisoning may include:

  • Burnouts or redness around the mouth and lips.

  • Chemicals, such as gasoline.

  • Vomiting.

  • Difficulty while breathing.

  • Drowsiness.

  • Confusion or altered mental status.

What Are the Types of Poisoning in Children?

  • Medications: A child may ingest medicines that are reachable to them, or parents may unintentionally give a higher dose that results in medication poisoning. Sometimes exposure to psychiatric medications such as antidepressants etc.

  • Household Products and Pesticides: The ingestion or inhalation of household substances, such as bleach or toilet cleaner, detergent, pesticides or insecticides, paint thinners, and oven or drain cleaners, can damage a child’s gastrointestinal tract or airway. Some can also burn the skin or eyes.

  • Carbon Monoxide: It is a colorless, odorless, and poisonous gas emitted from fuel-burning appliances that are not working correctly or not adequately vented, like heaters, furnaces, ovens, clothes dryers, gas water heaters, portable generators and stoves, and automobiles. Carbon monoxide in low concentration can cause flu-like symptoms such as fatigue and nausea. Higher concentrations can lead to difficulty breathing, loss of consciousness, and heart damage.

  • Household Plants: Some plants like daffodils, dumb cane, foxglove, hydrangea, and lilies contain toxins that may affect the stomach, heart, respiratory system, or skin. Most commonly, it causes only mild gastrointestinal (GI) symptoms.

  • Alcohol, Nicotine: Alcohol poisoning can lead to low blood sugar, seizures, and coma. Cigarettes, cigars, chewing tobacco, and nicotine gum turn out to be poisonous if ingested by an unattended child. Nicotine patches, if ingested or come in contact with the skin, can cause nausea, vomiting, or seizures.

  • Hydrocarbons: Gasoline, kerosene, lamp oil, lighter fluid, paint thinners, and motor oil, if unintentionally ingested, can affect the respiratory and central nervous systems.

  • Batteries: Found items like watches, calculators, remote controls, and battery-powered toys. Children may swallow small batteries containing alkaline chemicals that may leak or can generate an electrical current, which can burn holes in the esophagus.

  • Personal Care Products: Personal care products, such as nail polish remover or perfume, can be poisonous if ingested. It may lead to symptoms such as vomiting, drowsiness, or difficulty breathing.

How to Prevent Poisoning in Children?

  • Call an emergency if the child is experiencing chest pain or difficulty breathing, or is unconscious.

  • Storage the poisonous items properly.

  • Maintain the appliances and heaters.

  • Give the correct medication dose.

  • Never leave a child unattended.

What Is the Diagnosis Process in Poisoning in Children?

Emergency physicians diagnose poisoning in children based on their medical history, physical examination, and tests. If the toxin is unknown, testing is required to determine the cause of the poisoning.

  • Medical history and physical examination.

  • Blood tests.

  • Electrocardiogram.

  • X-rays.

  • A computed tomography scan (CT).

  • Magnetic resonance imaging (MRI) scan.

What Are the General Approaches to Poisoning?

The general approach can be divided into six phases:

  • Stabilization.

  • Lab assessment.

  • Decontamination of the GI tract, skin, or eyes.

  • Administration of an antidote.

  • Elimination of the toxin.

  • Observation and disposition.

What Are the Treatments for Poisoning in Children?

Emergency doctors determine the type of poison and then use different treatments to reduce symptoms and help restore the body’s normal functions.

  • Gastrointestinal Decontamination: This technique helps to prevent and reduce the absorption of toxic substances in the gastrointestinal tract.

  • Orogastric Lavage: In rare situations, when a toxic substance gets fully absorbed into the body in no time and requires removal to prevent toxicity, a doctor performs orogastric lavage. A tube is passed to the stomach through the mouth, and fluid is instilled through the tube and then suctioned back out.

  • Activated Charcoal: It is an odorless and tasteless black powder mixed with water, used to reduce the number of toxins that are absorbed into the bloodstream. The patient can drink or administer the activated charcoal solution through a nasogastric tube.

  • Whole-Bowel Irrigation: In this, toxins are “flushed” from the gastrointestinal tract. Flushing helps to push the contents out of the body. A child can drink the electrolyte solution or insert a tube through the nose or mouth into the stomach. Electrolyte fluid is passed through the line until clear fluid exits the rectum.

  • Antidote: An antidote is a medication that neutralizes or counteracts the poison effect in the body. Not every toxin has a remedy. Antidote medications are administered through an intravenous (IV) line.

What Are the Different Types of Poisoning and Methods Which Require Immediate Treatment?

  • Swallowed Poison: Ask the child to spit out any remaining substance. Do not make the child vomit or use Ipecac syrup.

  • Battery Swallowed: If the child has swallowed a button-cell battery or a battery is stuck in the nose, ear, or throat, rush to a hospital emergency department immediately. Severe tissue damage can take place in as little as two hours.

  • Skin Poison: Take off the child’s clothes and rinse the body with lukewarm water for at least 15 minutes.

  • Eye Poison: Flush the child’s eye, holding the eyelid open and pouring a stream of room temperature water for 15 minutes.

  • Poisonous Fumes: Move the child into fresh air immediately. Start cardiopulmonary resuscitation (CPR) if the child has stopped breathing, and do until the child breathes.

Conclusion:

Preventable accidental poisonings are still a remarkable cause of death among children. Drugs and corrosive and household agents are the most frequent agents causing poisoning in children. Multi-drug ingestion is usually intentional, performed by adolescents at a high admission rate.

Frequently Asked Questions

1.

How to Manage Poisoning in an Emergency?

Poisoning is managed by reducing the symptoms and restoring the body’s normal functions through the following approaches:
- Gastrointestinal Decontamination: This method aids in diminishing and restricting the uptake of harmful substances in the gastrointestinal tract.
- Orogastric Lavage: This procedure involves inserting a tube through the mouth into the stomach and introducing fluid through the tube, followed by subsequent action to extract the toxic material and fluids.
- Activated Charcoal: This is administered through a nasogastric tube and will help in reducing the toxins absorbed in the circulation.
- Whole-Bowel Irrigation: Electrolytes are passed through the body through a tube to flush out the toxins. 
- Antidote Administration: Medicine that counteracts the poison effect.

2.

What Is the Initial Step in Treating Poisoning?

The primary focus in treating a poisoned patient is similar to the management of critically ill patients or unstable patients, and the first step is to ensure ABC (airway, breathing, circulation). Alongside resuscitation, intensive care doctors will deal with severely poisoned patients by safeguarding their functional capability.

3.

In Which Route Do Children Get Poisoned?

The most common route of poisoning in children is due to ingestion of poisonous or harmful substances. Other common routes of poisoning include drugs and carbon monoxide inhalation. Poisoning is usually observed in children around the ages of one to five.

4.

What Is the ABCD in Poisoning Management?

Four steps to be followed for emergency management of poisoning include the following:
- Airway: The patient's airway should be examined, and if there is any obstruction or blockage, it has to be removed. 
- Breathing: Ensuring a patient's normal breathing is important. In case of impairment, supportive measures like oxygen administration should be done.  
- Circulation: Assessing a patient's circulation by checking blood pressure and pulse. In case of a compromise to circulation, administering intravenous fluids may be necessary.  
- Decontamination: Addressing the specific poisoning by decontaminating the patient through methods like administering activated charcoal, etc.

5.

What Are the Typical Signs and Symptoms of Poisoning?

Poisoning symptoms include the following:
- Being sick or feeling sick
- Stomach pain
- Diarrhea
- Drowsiness
- High temperature
- Loss of appetite
- Chills
- Skin rash
- Mental confusion
- Seizures
- Headache
- Irritability
- Breathing difficulties

6.

How Is Poisoning Categorized?

Poisoning is classified based on the route of exposure as follows:
- Ingestion Poisoning: It occurs through oral consumption of harmful substances.
- Inhalation Poisoning: It occurs through inhalation of poisonous gasses like fumes, harmful chemicals, toxins, etc.
- Dermal Poisoning: It occurs through skin contact and absorption of toxic substances into the circulation through the skin.
- Injection Poisoning: This occurs in drug overdose and involves the direct injection of harmful substances into the body.

7.

What Are the Adverse Outcomes of Poisoning in Children?

Certain poisons pose extreme toxicity, and even a minimal quantity can lead to severe complications such as seizures, cardiac or respiratory arrest, unconsciousness, end up in coma, and even fatality in children. Immediate treatment is necessary in positioning to prevent complications.

8.

What Is the Mechanism of Action of Poisoning?

The human body will process the poison after it has come in contact with the circulation and will produce a metabolized product that will further impact the vital organs like the lungs, liver, brain, blood, and kidneys. This toxic product induces substantial molecular changes within an organ, thereby disrupting its normal function.

9.

How Is Poisoning Termed in Pediatric Nursing?

Poisoning refers to harm or fatality resulting from the ingestion, physical contact, inhalation, or injection of various substances, including drugs, venoms, chemicals, or gasses. In many cases, certain substances, like drugs and carbon monoxide, exhibit toxicity only when present in elevated concentrations or doses.

10.

Can One Drink Water After Being Poisoned?

If the positioned individual is awake and alert, provide them a glass of water or milk to consume. This can help slow down the absorption of the poison into the body. However, if the person is experiencing weakness, seizures, etc., or is unconscious, refrain from giving anything orally.
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Dr. Veerabhadrudu Kuncham
Dr. Veerabhadrudu Kuncham

Pediatrics

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