2. POISONING
BY
Dr. HAMDY ABO HAGAR
Lecturer of Pediatrics

3. Ingestion of toxic products
by children is a common
occurrence.
Children under 5 years of
age account for 80% of
recorded cases of poison
ingestion.
INCIDENCE

4. Poison Identification

5. Poison identification
1. The initial history should include the
identification of the product ingested
(containers or bottles should be brought).
2. Physical examination will often reveal
supporting evidence for a particular
ingestion.

6. Poison identification
3. When the nature of the substance
ingested is unknown, the list of common
symptoms or signs are presented in table

7. Poison identification
4. The specific substance causing a
poisoning should be confirmed by
qualitative analysis performed on blood or
urine.
Gastric fluid analysis will be of value if
done within 2-3 hours of ingestion.

8. Poison identification
HISTORY
EXAMINATION
MANIFESTATIONS
ANALYSIS

10. Toxidromes
(Symptoms and signs of common toxic exposures)

11. Toxidromes
System involved
(CNS)
Substance involved
Depression and
coma
- Sedatives,
- Narcotics,
- Tranquilizers,
-Tricyclic antidepressants,
- Anticonvulsants,
- Alcohol,
- Hypoglycemic agents,
- Hydrocarbons,
- lead, mercury, lithium and CO.

12. System involved
(CNS)
Substance involved
- Convulsions - Amphetamines,
- Xanthines,
- Sympathomimetics,
- Psychotropics, cocaine,
- Ergot,
- Strychnine,
- organophosphates,
Toxidromes

13. System involved
(CNS)
Substance involved
- Hallucinations Amphetamines,
psychotropics,
alcohol withdrawal,
antihistamines,
cocaine,
tricyclic antidepressants.
Toxidromes

14. Toxidromes
System involved
(CNS)
Substance involved
- Hyperpyrexia Atropine, salicylates

15. Toxidromes
System involved
(CVS)
Substance involved
- Arrhythmias - Digitalis,
quinidine,
tricyclic antidepressants,
cocaine

16. Toxidromes
System involved
(CVS)
Substance involved
- Tachycardia -Amphetamines,
-xanthines,
sympathomimetics,
- cocaine,
-tricyclic antidepressants

17. Toxidromes
System involved
(CVS)
Substance involved
- Bradycardia -Beta blockers,
cardioglycosides,
-quinidine,
-calcium-channel blockers.

18. Toxidromes
System involved
(CVS)
Substance involved
- Hypotension - Antihypertensive agents,
tricyclic antidepressants,
narcotics

19. Toxidromes
System involved
(GIT)
Substance involved
- Nausea,
vomiting, and
diarrhea
- Almost any toxic substance
can produce these
symptoms and signs.

20. Toxidromes
System involved
(GIT)
Substance involved
- Increased
salivation
- Insecticides

21. Toxidromes
System involved
(GIT)
Substance involved
- Decreased
salivation
- Antihistaminic,
antimuscarinic agents

22. Toxidromes
System involved
(Respiratory )
Substance involved
- Hypoventilation - CNS-depressant agents

23. Toxidromes
System involved
(Respiratory )
Substance involved
- Hyperventilation -Salicylates,
-cocaine,
-nicotine,
- CO2

24. Toxidromes
System involved
(Ocular)
Substance involved
- Mydriasis -Atropine,
sympathomimetics,
psychotropics,
-cocaine

25. Toxidromes
System involved
(Ocular)
Substance involved
- Miosis - Narcotics,
- Organophosphate
insecticides,
- Parasympathomimetics

26. Toxidromes
System involved
(Cutaneous)
Substance involved
- Cyanosis -Nitrites,
-aniline dyes

27. Toxidromes
System involved
(Cutaneous)
Substance involved
- Jaundice -Carbon tetrachloride,
benzene,
-phenothiazines

29. Supportive therapy:
1. Cardiopulmonary support.
The ABCs items of cardiopulmonary
resuscitation are applied for poisoned
child.

30. Supportive therapy:
2. Fluid support.
Replace the previous and ongoing
fluid losses while correcting electrolyte
disturbances.

31. Supportive therapy:
3. Hematologic support.
Correction of hemolytic anemias with
packed RBCs or exchange transfusion.

32. Supportive therapy:
4. CNS support.
For control of seizures and prolonged
care of comatose child.

33. Supportive therapy:
5. Renal support.
Renal function is monitored and
hemodialysis is instituted as needed.

34. Gastrointestinal decontamination:
A) Gastric evacuation:
 It is the cornerstone of intervention
after a toxic ingestion. Its efficacy falls
when it is instituted more than one
hour after an ingestion.

35. Gastrointestinal decontamination:
 Ipecac syrup
Is the method of choice for gastric
emptying, where it induces emesis
within 15 minutes of intake.

36. Gastrointestinal decontamination:
 Orogastric lavage
Is as effective as ipecac and offers
the advantage of speed and the
prompt administration of adsorbent
and cathartic.

37. Gastrointestinal decontamination:
 Orogastric lavage

38. Gastrointestinal decontamination:
B) Adsorbents:
 Activated charcoal forms a stable
complex with the toxin, thus
preventing its absorption.
 It is not given before ipecac and
is not effective against metals,
alcohols, hydrocarbons, or
caustics.
 It is given in a dose of 1gm/kg in
water orally.

39. Gastrointestinal decontamination:
C) Cathartics:
• As magnesium citrate and sorbitol.
• They hasten transit of gastrointestinal
contents, thus decreasing systemic
absorption of the toxin.

40. Elimination enhancement:
1. Fluid and osmotic diuresis by intake of
hypertonic fluid.
2. Diuretics,
such as frusemide (2 mg/kg/dose) are
used to increase urine output.

41. Elimination enhancement:
3. Ionized diuresis;
excretion of acidic compounds, such
as salicylates and barbiturates, is
enhanced by alkalinization of urine
which is accomplished by IV sodium
bicarbonate.

42. Elimination enhancement:
4. Extracorporeal poison removal,
such as by hemodialysis, peritoneal
dialysis and exchange transfusion.

43. Antidotes

44. Antidotes
The number of ingestions for
which there is a specific
antidote is small.

45. Antidotes
Poison Antidote dose
-Carbon
monoxide
-Chlorpromazine
and
metoclopromide
(primpran)
Oxygen
Diphenhy
dramine
- 100% or
hyperbaric O2
0.5 -1 mg/kg, IV
or IM.

46. Antidotes
Poison Antidote dose
-Cyanide
-Organic
phosphoro
us
Na nitrite, Na
thiosulphate
Pralidoxime
Atropine
- depends on
hemoglobin level.
20-40 mg/kg, IV
over 15-30 min
0.1 mg/kg, IV every
10-30 min until
pupillary dilatation.

47. Antidotes
Poison Antidote dose
- Opiates,
narcotics
- Iron
Naloxone
(Narcan)
Deferoxamine
- 0.1 mg/kg, IV,
may be repeated
twice.
10–15 mg/kg/hr, (IV
infusion)

48. Antidotes
Poison Antidote dose
-Isoniazide
-Methemo
globinemia
-Lead
Pyridoxine
(B6
)
Methyline
blue
EDTA
5 gm, IV
1-2 mg/kg, IV over
10 min
250 mg/M2
/dose,
IM, every 4 hrs.

49. How can I protect my child?
The most important and
practical measure is to ensure
toxic substances are completely
out of reach in the first place.
Make a thorough check of your
house and garden, removing
any harmful products and
placing them in a securely
locked cabinet.

50. THANK YOU