How to manage children with various types of poisoning in children?

Managing poisoning in children involves a combination of immediate interventions, specific treatments, and ongoing supportive care. Here’s a comprehensive guide for managing children with various types of poisoning:

General Principles

1.     Initial Assessment and Stabilization

·       Airway, Breathing, Circulation (ABCs): Ensure the airway is clear, provide oxygen if needed, and maintain circulation with IV fluids if necessary.

·       Vital Signs: Monitor heart rate, respiratory rate, blood pressure, and oxygen saturation.

2.     History and Identification

·       Obtain detailed information about the substance involved, amount ingested, time of ingestion, and route of exposure (oral, inhalation, dermal).

·       Identify the poison if possible, using containers, labels, or input from caregivers.

3.     Decontamination

·       Gastrointestinal: Consider activated charcoal (1 g/kg, up to 50 g) if the child is alert and the ingestion occurred within the past hour. Avoid if the child has a compromised airway.

·       Dermal: Remove contaminated clothing and wash the skin thoroughly with soap and water.

·       Ocular: Rinse the eyes with water or saline for at least 15 minutes.

4.     Symptomatic and Supportive Care

·       Seizures: Use benzodiazepines (e.g., diazepam, lorazepam) if seizures occur.

·       Hypotension: Administer IV fluids and vasopressors if needed.

·       Arrhythmias: Monitor and treat cardiac arrhythmias according to standard protocols.

Specific Poison Management

1.     Acetaminophen (Paracetamol) Poisoning

·       Antidote: Administer N-acetylcysteine (NAC) as soon as possible. The dosing regimen includes a loading dose followed by maintenance doses over 20 hours (IV) or 72 hours (oral).

·       Monitoring: Check liver function tests, acetaminophen levels, and coagulation profile.

2.     Salicylate (Aspirin) Poisoning

·       Decontamination: Consider activated charcoal if within the appropriate time frame.

·       Alkalinization: Administer sodium bicarbonate to alkalinize the urine and enhance salicylate excretion.

·       Monitoring: Check salicylate levels, electrolytes, and arterial blood gases.

3.     Iron Poisoning

·       Antidote: Administer deferoxamine if serum iron levels are significantly elevated or if severe symptoms are present.

·       Monitoring: Monitor serum iron levels, liver function, and renal function.

4.     Opioid Poisoning

·       Antidote: Administer naloxone. The initial dose is 0.1 mg/kg, which can be repeated as needed.

·       Supportive Care: Provide respiratory support due to the risk of respiratory depression.

5.     Organophosphate Poisoning

·       Antidotes: Administer atropine and pralidoxime (2-PAM).

·       Monitoring: Monitor cholinesterase levels, respiratory function, and cardiovascular status.

6.     Benzodiazepine Poisoning

·       Antidote: Administer flumazenil with caution, considering the risk of seizures.

·       Supportive Care: Monitor respiratory and cardiovascular status closely.

7.     Caustic Ingestion (Acids or Alkalis)

·       Do Not Induce Vomiting or give activated charcoal.

·       Supportive Care: Provide pain management, IV fluids, and monitor for signs of esophageal or gastric perforation.

8.     Carbon Monoxide Poisoning

·       Oxygen Therapy: Administer 100% oxygen via a non-rebreather mask or consider hyperbaric oxygen therapy in severe cases.

·       Monitoring: Check carboxyhemoglobin levels and monitor for neurological symptoms.

9.     Anticholinergic Poisoning

·       Antidote: Administer physostigmine if severe symptoms are present and under careful monitoring.

·       Supportive Care: Control agitation and seizures with benzodiazepines.

10.   Methanol/Ethylene Glycol Poisoning

·       Antidotes: Administer fomepizole or ethanol.

·       Additional Treatment: Hemodialysis may be required in severe cases.

·       Monitoring: Monitor electrolytes, renal function, and acid-base status.

Conclusion

Managing pediatric poisoning requires a thorough and systematic approach, starting with stabilization and identification, followed by appropriate decontamination, administration of specific antidotes, and continuous supportive care. Always involve a poison control center for guidance and ensure close monitoring of the child’s clinical status throughout the treatment.

Links to manage different kinds of poisoning in children

Hydrocarbon poisoning in children

Benzodiazepine poisoning in children

Benzodiazepine Toxicity

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