POISONING

Accidental poisoning is common in children under 3 years of age. Usually a previously well child suddenly falls sick. For the older child, especially the adolescent, it may be a suicide attempt.

Common poisons include

  • Paracetamol
  • Aspirin
  • Pesticides (organophosphates)
  • Kerosene (paraffin).
  • Other poisons include drugs being taken by any member of the family.

General Principles of Management

  • Parent /caregiver is encouraged to try to identify the type of poison the child has taken.
  • If possible, carry the container to the health facility.
  • Do not give the child anything to drink and do not make the child vomit.
  • In the case of insecticides like diazinon, remove the child’s clothing and give the child a bath.
  • In all cases, parents should be encouraged to take the child to a health facility as soon as possible.

Note that most childhood poisoning is preventable by putting drugs and dangerous chemicals out of reach for children. Take full history and try to identify the poisoning agent. Severe poisoning requires hospital admission for
appropriate management.

Decontamination

  • Stomach: Do not induce vomiting. A gastric lavage is possible if poison was ingested within an hour of presentation to the health facility. Activated charcoal if available can be given. Gastric decontamination is contraindicated in
    unconscious patients or those who have ingested corrosives or kerosene.
  • Skin: Remove clothing and wash thoroughly
  • Eyes: Irrigate with water or saline.
  • Give specific antidote if indicated.

Clinical Features and Treatment of Common Poisonings

PARACETAMOL POISONING

Clinical Features

There are four stages of paracetamol poisoning that are recognized if a child has ingested 140mg/kg or more:

  • Stage 1: First 24 hours – Anorexia nausea and vomiting
  • Stage 2: 24–48 hours – Signs of hepatic dysfunction – jaundice, bleeding
  • Stage 3: 72–96 hours – Peak liver dysfunction with possible hepatic encephalopathy
  • Stage 4: 4 days–2 weeks – Resolution of liver dysfunction

Management

  • Treatment can only be done in hospital so admit all children.
  • Treatment: Give N-acetylcysteine IV or oral within 8 hours of ingestion. Loading dose 150mg/kg in 3ml/kg 5% dextrose IV infusion over 15 minutes. Then 50ml/ kg 5% dextrose over 4 hours. Then 100mg/kg of 5% dextrose over 16 hours.

KEROSENE (PARAFFIN)

Clinical Features

Features depend on amount ingested and if there is aspiration. Aspiration results in severe respiratory distress due to pulmonary oedema. Absorbed kerosene leads to encephalopathy with varying degrees of altered consciousness.

Management

Admit all children and monitor as follows:

  • Vital signs
  • Urine output (1–2ml/kg/hr); catheterize if necessary
  • Level of consciousness
  • Watch for complications and treat accordingly.

ORGANOPHOSPHATES (E.G., DIAZINON)

Clinical Features

  • Headaches
  • Weakness
  • Vomiting
  • Colicky abdominal pain
  • Profuse cold sweating
  • Hypersalivation
  • Muscular twitching
  • Fasciculations
  • Diarrhoea
  • Tenesmus
  • Convulsions
  • Dyspnoea with bronchoconstriction
  • Constricted pupils (meiosis)
  • Bilateral crepitations.

Management

  • Decontaminate skin (see above)
  • Gastric lavage
  • IV atropine 0.05mg/kg over 15 min. Repeat every 15 min until full atropinization and maintain on SC atropine 4–6 hours x 24–48 hours.
  • If muscle weakness: Pralidoxime 30mg/kg IV infusion repeat 4 hourly, 12–24 hours depending on response.
  • Refer/consult if not sure how to manage.

Prevention of Home Accidents and Poisoning

Every parent is encouraged to keep dangerous items including kerosene and drugs out of reach of young children. Protect children from fires. Avoid leaving small children locked up in houses. Do not store potentially poisonous
compounds in soft drink bottles.