Pediatric Poisonings

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Pediatric Poisonings

• Margaret Thompson, MD
• Medical Director - Ontario Regional Poison
  Information Centre
• Emergency Physician St. Michaels Hospital

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Epidemiology - Pediatric
AAPCC Annual Report 2003
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AAPCC 2002 DATAPediatric Exposures Involved
Substances

•  Substance Percentage ()
• Cosmetics/Personal Care 13.3
• Cleaning Substances 10.3
• Analgesics 7.4
• Foreign Bodies 7.1
• Topicals 7.0
• Plants 5.1
• Cough cold preparations 5.1
• Pesticides 4.1
• Vitamins 3.7
• GI preparations 3.2
• Antimicrobials 2.8

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EPIDEMIOLOGY - PEDIATRICS
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EPIDEMIOLOGY - PEDIATRICS
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Epidemiology - Pediatrics
AAPCC 2003 Annual Report
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Epidemiology - Pediatrics
2003 AAPCC Annual Report
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Epidemiology PediatricsAAPCC Data 2003 Deaths
lt 6 yrs
Bites 2
CO 7
OTC meds 12
narcotics 3
anticonvulsants 2
herbicides 2
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When a pill can kill

• Acetonitrile  
• Ammonium fluoride   
• Benzocaine   
• Brodifacoum (others)   
• Butyrolactone
• Calcium antagonists   
• Camphor   
• Chloroquine   
• Chlorpromazine (others)   
• Clozapine   
• Desipramine (others)   
• Diphenoxylate  
•  

• Hydrocarbons
• Hyoscyamine sulfate  
• Imidazoline products   
• Lindane   
• Methadone   
• Methanol   
• Methyl salicylate
• Oral hypoglycemics  
• Pennyroyal oil   
• Quinine   Salt   
• Selenious acid   
• Theophylline

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Prevention Implications

• Inaccessible containers
• (child-resistant, locked)
• Original containers
• Behind the counter
• Medication record

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ONTARIO REGIONAL POISON INFORMATION CENTRE

• WHAT DO WE NEED TO KNOW?

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ONTARIO REGIONAL POISON INFORMATION CENTRE

• WHO?
• WHAT?
• HOW MUCH?
• WHEN?
• WHERE?
• HOW?
• WHY?

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APPROACH TO THE POISONED PATIENT

• Airway
• Breathing
• Circulation
• Drugs - ACLS
• - Universal Antidotes
• Decontaminate
• Expose
• Full Vitals/Investigations
• Give Antidotes
• GO BACK

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DECONTAMINATIONOPTIONS

• ? EMESIS
• ?LAVAGE
• ? ACTIVATED CHARCOAL
• ?CATHARTIC
• ?WHOLE BOWEL IRRIGATION
• ?SURGICAL

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ANTIDOTESeg.ACETAMINOPHEN
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ACETAMINOPHEN
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• Suggested Reading
• Bryant S. Management of toxic exposures in
  children, Emerg Med Clin North Am, 01-FEB-2003
  21(1)101-19