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POISONING IN CHILDREN

POISONING IN CHILDREN. Nearly always accidental Common once: kerosene Cleaning agents CO Prescription medicatio n . Always kept in mind even in absence of history of poisoning. Basics :. Confirm Identify quality Route & quantity Time

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POISONING IN CHILDREN

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  1. POISONING IN CHILDREN Nearly always accidental Common once: kerosene Cleaning agents CO Prescription medication

  2. Always kept in mind even in absence of history of poisoning

  3. Basics: • Confirm • Identify quality • Route & quantity • Time • Illness or drugs before

  4. possible features: • Coma • Convulsion • Arrhythmias • GI symptoms • Acidosis • Odor • Color • sweating • Dryness • Gray cyanosis • Eye changes • Fever

  5. Investigations • Blood counts, gases & osmolality • ECG • Chest & abdominal x-ray • Toxicology

  6. Management • ABC & IV access • Monitoring • Removal • cleaning • Lavage • Ipecac • Charcoal • Antidote

  7. Prevention • Protection of the child by: X child reach places X wrong containers • child proof packing 2) Parent education • potential household poisons • Toddler supervision • Information's on management

  8. KEROSENE POISONING • Most common here & leastcommon elsewhere • Affects lungs & CNS • Both vomiting induction & lavage are contraindicated • Charcoal is not effective • ? Steroid & antibiotic

  9. PARACETAMOL POISONING More than 150mg/kg is hepatotoxic Clinical stages • Day 1: GI symptoms • Day 2: rising TSB,SGOT,SGPT & PT • Day 3,4&5: peak hepatotoxicity • Day 6&7: possible recovery Treatment ; charcoal & NAC

  10. TRICYCLIC ANTIDEPRESSANTS POISONING • Cardiac effects • CNS effects • Anticholinergic effects Treatment; • Lavage • Charcoal • Treat convulsion • Treat cardiac effects: • IV normal saline • Induce alkalemia • Lidocaine • Defibrillation

  11. IRON POISONING More than 40mg/kg is toxic Toxic effects on; • GI • CVS • CNS • Metabolic • Liver

  12. Iron poisoning (continued) Clinical phases: • Phase 1 (1st 6hr.) : bloody diarr. & abd. Pain • Phase 2 (6-24hr.s): apparent recovery • Phase 3 (24-48r.s): shock,acidosis,convulsion, liver affection • Phase 4 (4-6weeks): GI stricture , hepatotoxicity

  13. Iron poisoning (continued) Treatment: • GI decontamination • General supportive care • Chelation • Dialysis • Exchange transfusion

  14. CAUSTIC POISONING Acids……….coagulation necrosis Alkalis……..liquefaction necrosis Drooling , stridor, dysphagia & erythema -+ulceration Treatment: • Irrigate • No induction of vomiting • Oral dilute milk or water • ? Steroid • Esophagoscopy

  15. SALICYLATE POISONING More than 150mg/kg is toxic Respiratory alkalosis…………metabolic acidosis Tinnitus,fever,coma & circulatory collapse Treatment: • Lavage up to 4hours • Charcoal • Fluid & electrolyte • Vitamin K , ? Blood , FFP & clotting factors • Forced alkaline diuresis • Hemodialysis

  16. CO POISONING Causes cellular anoxia by: • Displacing O2 on Hb • Shifting to left causes decrease O2 delivery at tissues • Affecting function of intracellular cytochrome oxidase

  17. CO poisoning ( continued) Other effects: • Bronchopulmonary • CNS • Cardiac • Muscles • Skin

  18. CO poisoning ( continued) Treatment: 100% O2 under pressure 5 hr. in room air 1 hr. in 100% O2 30 min. in 100% O2 under pressure

  19. SMOKE INHALATION Causes upper airway burn( hot smoke) & cellular hypoxia ( from bronchopneumonia, CO & cyanide) Treatment: ETT, O2 & Na thiosulfate

  20. LEAD POISONING • Paint • batteries • printing • Surma • Pica Encephalopathy, bone lines, resistant anemia Treatment: • Removal of source • Decontamination • Chelation( BAL)

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