import json

data = {
 "topic": "Acute Poisoning",
 "slug": "acute-poisoning",
 "category_id": 15056,
 "summary": "Acute poisoning is a common pediatric emergency, most often accidental in young children and intentional in adolescents, managed with an ABCDE-based systematic approach since most substances lack a specific antidote and supportive care is the mainstay of treatment.",
 "written_by": "claude-sonnet",
 "references": [
  {"title": "Pediatrics for Practitioner (Sharad Thora)", "author": None, "pages": [158]},
  {"title": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga)", "author": "CamScanner", "pages": [714]},
  {"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition", "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.", "pages": [373, 376, 1501]},
  {"title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub", "author": None, "pages": []},
  {"title": "MedStudy Pediatrics Core 11th Edition 2024-2025", "author": None, "pages": [249]},
  {"title": "The Harriet Lane Handbook (The Johns Hopkins Hospital)", "author": None, "pages": [86]},
  {"title": "The Harriet Lane Handbook 22nd Edition (2020) (The Johns Hopkins Hospital)", "author": None, "pages": [86]},
  {"title": "Netters Pediatrics (Florin Т., Ludwig St.)", "author": None, "pages": [83]}
 ],
 "short": [
  {"title": "In short", "content": (
   "- Acute poisoning is a common and important cause of pediatric morbidity and mortality, especially in developing countries\n"
   "- In one series, household products caused about 47% of pediatric poisonings (kerosene, pyrethroids, rodenticides, mercury thermometers, phenyl, detergents, corrosives), drugs about 22% (benzodiazepines, anticonvulsants, thyroid hormone, iron, paracetamol), agricultural pesticides about 9% (aluminum phosphide, organophosphates, organochlorines), industrial chemicals about 8%, bites/stings about 3%, and plants/plant derivatives about 1.5%\n"
   "- The majority of poisonings in children under 5 are accidental (reflecting curious, exploratory behavior and mouthing of objects); in older children and teenagers, poisoning is more often intentional\n"
   "- Seven basic routes of poison exposure: oral (ingestion), ocular, dermal, inhalational, transplacental, parenteral, and envenomation\n"
   "- Acute poisoning is typified by the curious young child who accesses a medication or cleaning product, or the adolescent who takes an intentional polypharmaceutical overdose; chronic poisoning develops over time from accumulation (e.g., lead, other heavy metals, or repeated supratherapeutic acetaminophen dosing)\n"
   "- Initial evaluation follows ABCDs: Airway/Antidotes, Breathing, Circulation, Disability/Decontamination; most substances have no specific antidote, so supportive care is the mainstay of treatment\n"
   "- In any child with altered mental status, check a bedside glucose; obtain an ECG for cardiotoxic or unknown ingestions (e.g., widened QRS suggests tricyclic antidepressant overdose)\n"
   "- Routine urine drug screening is often unhelpful, since it misses many substances including cyanide, clonidine, organophosphates, beta-blockers, calcium channel blockers, and iron; specific blood levels are useful for certain poisonings (e.g., acetaminophen)\n"
   "- Acetaminophen overdose progresses through phases: Phase 1 (first 24 hours) nonspecific nausea/malaise/vomiting; Phase 2 (24-72 hours) resolution of those symptoms with emerging RUQ pain, hepatomegaly, and rising transaminases (the toxic NAPQI metabolite is hepatotoxic)\n"
   "- The US poison control hotline (1-800-222-1222) should be available at all times to call for guidance on any suspected poisoning"
  )}
 ],
 "long": [
  {"title": "Definition", "content": (
   "Acute poisoning refers to toxic exposure to a substance occurring over a short time frame, in contrast to chronic poisoning, which develops gradually as a substance accumulates in the body (for example, environmental lead exposure or repeated supratherapeutic acetaminophen dosing). There are seven recognized routes of poison exposure: oral (ingestion, the most common in children), ocular, dermal, inhalational, transplacental, parenteral, and envenomation. Most poisonings seen in emergency departments are acute, typified either by a curious young child gaining access to a medication or household product, or an adolescent taking an intentional polypharmaceutical overdose."
  )},
  {"title": "Epidemiology", "content": (
   "Acute poisoning is a common and challenging pediatric emergency and an important cause of morbidity and mortality, particularly in developing countries. Common agents vary by setting: in high-income countries, pharmaceuticals and household products/chemicals predominate, while in low- and middle-income countries, pesticides, kerosene, and cleaning agents are common contributors alongside pharmaceuticals. One series breaks down causes as household products (about 47%, including kerosene, pyrethroids, rodenticides, mercury thermometers, phenyl, detergents, and corrosives), drugs (about 22%, including benzodiazepines, anticonvulsants, thyroid hormone, iron, and paracetamol), agricultural pesticides (about 9%, including aluminum phosphide and organophosphates/organochlorines), industrial chemicals (about 8%), bites and stings (about 3%), and plants/plant derivatives (about 1.5%). Children are inherently susceptible because of their curious, exploratory nature and tendency to place objects in their mouths. The majority of poisonings in children younger than 5 years are accidental, while poisonings in older children and adolescents are more often intentional."
  )},
  {"title": "Etiology", "content": (
   "Common pediatric poisoning exposures include household chemicals and cleaning products, pharmaceuticals (including both prescription and over-the-counter medications such as acetaminophen and iron), and, particularly in agricultural settings, pesticides. Adolescent-specific etiologies include recreational and stimulant drug use - amphetamines, MDMA (\"ecstasy\"), methamphetamine, diverted ADHD stimulant medications such as methylphenidate, and newer designer drugs such as synthetic cannabinoids (\"spice,\" \"K2\") and synthetic cathinones (\"bath salts,\" \"plant food\"). Chronic poisoning differs mechanistically from acute poisoning in that toxicity accumulates over time and the diagnosis can be more challenging because the source and toxic process are not always immediately apparent."
  )},
  {"title": "Clinical features", "content": (
   "Presentation varies enormously depending on the substance and route of exposure, ranging from minimal symptoms to life-threatening cardiorespiratory compromise. Level of consciousness can change rapidly in serious intoxications and may herald impending cardiorespiratory failure, so mental status should be assessed rapidly and repeatedly using a scale such as the Glasgow Coma Scale or AVPU (Alert, responds to Verbal stimulation, responds to Pain, Unresponsive); pupillary size and reactivity should also be quickly assessed. Acetaminophen overdose classically progresses through recognizable phases: Phase 1 (first 24 hours) with nonspecific nausea, malaise, and vomiting; Phase 2 (24-72 hours), during which the initial symptoms resolve but right upper quadrant pain, hepatomegaly, and rising transaminases develop, reflecting hepatotoxicity from the NAPQI metabolite. Acute fluoride toxicity can cause sudden nausea, abdominal pain, vomiting, diarrhea, cytotoxic effects, hyperkalemia, seizures, and multiple organ failure, with severity depending on the ingested dose."
  )},
  {"title": "Diagnostics", "content": (
   "In any child with altered mental status from suspected poisoning, obtain a bedside glucose immediately. An ECG should be obtained for cardiotoxic or unknown ingestions, looking for changes suggestive of a specific toxin requiring targeted intervention - for example, a widened QRS complex suggests tricyclic antidepressant overdose. Routine urine drug screening is often unhelpful, as many clinically important substances are not detected by standard panels, including cyanide, clonidine, organophosphates, beta-blockers, calcium channel blockers, and iron. Specific blood levels are useful and should be obtained for certain known or suspected poisonings, such as acetaminophen."
  )},
  {"title": "Treatment", "content": (
   "Initial management of any poisoning follows a systematic ABCDs approach: Airway/Antidotes, Breathing, Circulation, and Disability/Decontamination. Most poisoning substances do not have a specific antidote, so supportive care remains the mainstay of treatment for the majority of exposures. Decontamination strategies (e.g., activated charcoal, whole-bowel irrigation) may be used depending on the substance, timing, and clinical scenario; single-dose cathartics are sometimes used alongside activated charcoal, though repeated dosing can cause diarrhea, cramping, and hypernatremic dehydration, and overall efficacy of cathartics remains equivocal. The American Association of Poison Control Centers hotline (1-800-222-1222) should be available at all times for guidance on managing a specific suspected poisoning, since specific management (antidotes, decontamination approach, disposition) is highly substance-dependent."
  )},
  {"title": "Complications", "content": (
   "Complications depend heavily on the substance and exposure severity, ranging from full recovery to permanent organ damage or death. Some toxic exposures can cause permanent cardiac, liver, renal, or CNS damage, with outcomes of severe poisoning ranging from complete recovery to a vegetative state or intermediate degrees of mental injury; delayed neuropsychiatric deficits are a recognized primary long-term sequela of certain poisonings."
  )}
 ],
 "clinical": [
  {"title": "Initial approach at the bedside", "content": (
   "For any child presenting with known or suspected poisoning, start with the ABCDs: secure the Airway, ensure effective Breathing, support Circulation, and assess Disability (level of consciousness via Glasgow Coma Scale or AVPU, and pupillary size/reactivity) while considering the need for empiric antidote administration and Decontamination. Obtain a bedside glucose immediately in any child with altered mental status. Get an ECG for any cardiotoxic or unknown ingestion, watching specifically for a widened QRS complex that would suggest tricyclic antidepressant toxicity and change management.\n\nDo not rely on a routine urine drug screen to rule out poisoning - it misses many important toxins (cyanide, clonidine, organophosphates, beta-blockers, calcium channel blockers, iron), so a negative screen should never be used to dismiss clinical suspicion. Send a specific blood level when a particular agent is suspected and a level is clinically actionable (e.g., acetaminophen, given its silent Phase 1 presentation and the importance of early identification before hepatotoxicity in Phase 2). Since most substances lack a specific antidote, focus resources on aggressive supportive care while calling the poison control hotline (1-800-222-1222) for substance-specific guidance on decontamination, antidote use if one exists, and disposition. In any child under 5 with an unexplained or repeated ingestion, or any presentation raising suspicion for an intentional or non-accidental cause, ensure appropriate psychosocial and safety evaluation is initiated alongside the medical workup."
  )}
 ]
}

with open("/tmp/acute-poisoning.article.json", "w") as f:
    json.dump(data, f, indent=1)
print("written")