{
 "topic": "Substance Intoxication",
 "slug": "substance-intoxication",
 "category_id": 15884,
 "passage_count": 14,
 "source_chars": 11740,
 "enough_material": true,
 "references": [
  {
   "title": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll)",
   "author": "Lissauer, Tom,Carroll, Will",
   "pages": [
    109,
    121
   ]
  },
  {
   "title": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga)",
   "author": "CamScanner",
   "pages": [
    714
   ]
  },
  {
   "title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "author": null,
   "pages": []
  },
  {
   "title": "Algorithms in Pediatrics",
   "author": null,
   "pages": [
    242
   ]
  },
  {
   "title": "Signs and Symptoms in Pediatrics",
   "author": "Henry M. Adam,Jane Meschan Foy",
   "pages": [
    106,
    600
   ]
  },
  {
   "title": "Netters Pediatrics (Florin \u0422., Ludwig St.)",
   "author": null,
   "pages": [
    79
   ]
  },
  {
   "title": "Berkowitz's Pediatrics",
   "author": "Berkowitz, Carol D.;",
   "pages": [
    616
   ]
  },
  {
   "title": "Pediatric Clinical Practice Guidelines and Policies",
   "author": "American Academy of Pediatrics (AAP);",
   "pages": [
    1258
   ]
  }
 ],
 "passages": [
  {
   "source": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll), p. 121",
   "text": "## Summary Accidental poisoning in children: - is common in toddlers and young children - most substances do not cause serious illness - when an ingestion has occurred, identify the agent and assess its toxicity to plan management - poisons potentially harmful in children include alcohol, acids and alkalis, bleach, digoxin, batteries, iron, paracetamol, petroleum distillates, salicylates, and tricyclic antidepressants - assess the social circumstances behind why it happened. ## **Acknowledgements** We would like to acknowledge contributors to the chapter on accidents and poisoning in previous editions, whose work we have drawn on: Jo Sibert (1st, 2nd, 3rd Edition, Environment), Barbara Phillips (2nd edition, Environment), Ian Maconochie (3rd Edition, Environment), Rebecca Salter (4th Edition, Accidents, Poisoning and Child Protection). ## ~~**Further reading**~~ ## **Websites (Accessed November 2016)** **Child Accident Prevention Trust (CAPT):** Available at: www.capt.org.uk."
  },
  {
   "source": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga), p. 714",
   "text": "manufacture, appropriate labeling and parental education. POISONING Acute childhood poisoning is a common and challenging pediatric emergency. Children are susceptible to poisoning because of their curious and exploring nature, and propensity to put virtually everything in their mouths. Common poisoning agents in high-income countries include pharmaceuticals, household products and chemicals; in low and middle-income countries, pesticides, kerosene, cleaning agents and pharmaceuticals are commonly involved. Majority of poisonings in children <5 years of age are accidental, while in older children and teenagers, these are largely intentional. Clinical Approach to Child with Suspected Poisoning The initial approach includes stabilization and rapid assessment of the airway, breathing, circulation and mental status. After initial assessment and stabilization of vital signs, general physical and neurological examination is done. Physical examination may show pallor (hemolysis), cyanosis (methemoglobinemia) or"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "by being in an environment where drugs of abuse are used (e.g., marijuana, cocaine, phencyclidine [PCP], methamphetamine) or manufactured. In any of these circumstances, the exposure can be sufficient to produce severe intoxication. Thus, knowledge of the epidemiology and manifestations of substance use becomes important in the management of children of all ages."
  },
  {
   "source": "Algorithms in Pediatrics, p. 242",
   "text": "_Pradeep K Sharma, Praveen Khilnani_ ## **INTRODUCTION** Various Indian studies report kerosene (30\u201350%), drugs (11%), pesticides (11%), snakebites (10\u201320%), corrosives, and household cleaning products as the common substance causing poisonings. Certain household items often ingested by children are proven to be nontoxic and harmless (Box 1). However, ingestion of excessive amount of these substances may lead to toxicity. ## **EVALUATION OF CHILDREN WITH SUSPECTED TOXIN INGESTION** The acute management generally begins in the emergency department with triage and the determination of appropriate decontamination and treatment regimens. Immediate attention to the patient\u2019s airway, breathing, and circulation (ABC) should be done and following the establishment of lifesaving supportive care, a detailed evaluation can be performed (Algorhithm 1). ## **HISTORY** A comprehensive history may be obtained from witnesses, family members, and friends. Nature of substance ingested,"
  },
  {
   "source": "Signs and Symptoms in Pediatrics, p. 600",
   "text": "children may be exposed to these substances by passive means transplacentally,[28] by ingestion of breast milk,[29] or by inhalation. Th ey may accidentally ingest alcohol, cigarettes, or other substances left within reach. A positive history may be diffi cult to elicit, and a toxicologic screen may not always be helpful; thus a strong index of suspicion is needed. Substance use or withdrawal should be considered in the diff erential diagnosis of any adolescent with chronic persistent irritability. In rare instances, intentional poisoning may be the cause of a child\u2019s distress."
  },
  {
   "source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 79",
   "text": "## **ETIOLOGY AND PATHOGENESIS** The cause of childhood poisoning can vary dramatically from one case to another, but the most frequent causes are ingestions of readily accessible household products such as cosmetics, hair products, cleaning substances, and analgesics. The most lethal or potentially lethal poisonings, however, are most commonly related to pharmaceuticals, including antimalarials, \u03b2-blockers, calcium channel blockers, camphor, antidiarrheals, salicylates, opioids, and tricyclic antidepressants (TCAs). The mechanism of toxicity varies from one agent to another, yet there are some classic presentations that can be seen with particular ingestions (Table 9-1). Ingestions that can be lethal in small doses are reviewed in more depth here. ## _Calcium Channel Blockers and Beta-Adrenergic Blockers_"
  },
  {
   "source": "Berkowitz's Pediatrics, p. 616",
   "text": "1. What history questions should be asked to help identify the substance ingested? 2. What physical examination findings can offer clues to the substance ingested and the seriousness of the ingestion? 3. What other diagnostic tests might be helpful in treating ingestion patients? 4. What are the management priorities? Ingestions are a common problem presenting to pediatric practitioners. Three scenarios frequently encountered are accidental ingestions by preschool-age children, intentional suicide attempts by adolescents, and recreational drug use. This chapter discusses the general approach to the child who has ingested a potentially poisonous substance. Ingestions of specific substances are beyond the scope of this chapter, as is toxicity occurring by dermal, ophthalmologic, and inhalational routes. The general approach to the history, physical examination, laboratory tests and diagnostic studies, and management, especially decontamination, is useful for all ingestions, however."
  },
  {
   "source": "Pediatric Clinical Practice Guidelines and Policies, p. 1258",
   "text": "ABSTRACT. Alcohol is the substance most frequently abused by children and adolescents in the United States, and its use is associated with the leading causes of death and serious injury at this age (ie, motor vehicle accidents, homicides, and suicides). Among youth who drink, the proportion who drink heavily is higher than among adult drinkers, increasing from approximately 50% in those 12 to 14 years of age to 72% among those 18 to 20 years of age. In this clinical report, the definition, epidemiology, and risk factors for binge drinking; the neurobiology of intoxication, blackouts, and hangovers; genetic considerations; and adverse outcomes are discussed. The report offers guidance for the pediatrician. As with any high-risk behavior, prevention plays a more important role than later intervention and has been shown to be more effective. In the pediatric office setting, it is important to ask every adolescent about alcohol use. (8/15) **http://pediatrics.aappublications.org/content/136/3/e718**"
  },
  {
   "source": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition, p. 1232",
   "text": "**http://pediatrics.aappublications.org/content/108/4/1030** ## **BINGE DRINKING (CLINICAL REPORT)** ## _Lorena Siqueira, MD, MSPH, FAAP; Vincent C. Smith, MD, MPH, FAAP; and Committee on Substance Abuse_ ABSTRACT. Alcohol is the substance most frequently abused by children and adolescents in the United States, and its use is associated with the leading causes of death and serious injury at this age (ie, motor vehicle accidents, homicides, and suicides). **SECTION 5/CURRENT POLICIES** **1214**"
  },
  {
   "source": "Pediatrics for Practitioner (Sharad Thora), p. 158",
   "text": "Acute poisoning is a common pediatric emergency and one of the important causes of morbidity and mortality in children especially in the developing countries. Patient generally presents with varying signs and symptoms in emergency. On arrival of the patient assessment of the danger should be done. Irrespective of the substance\u00ad ingested look for the requirement of the support of airway, ventilation and circulation for basic life support. After initial assessment and stabilization the identification and quantification of the poison should be sought. ## **Epidemiology** - Household products (47%): Kerosene, pyrethroids, rodenticides, thermometer mercury, phenyl, detergents, corrosives, etc. - Drugs (21.8%): Benzodiazepine, anti\u00ad convulsants, thyroid hormone, iron, paracetamol, etc. - Agricultural pesticides (9.1%): Aluminum phosphide, organophosphorus, organochlorines, etc. - Industrial chemicals (7.9%). - Bites and stings (3.2%). - Plant and its derivatives (1.5%)."
  },
  {
   "source": "Signs and Symptoms in Pediatrics, p. 106",
   "text": "## **Toxic Ingestion** Ingestion of a toxin represents a major cause of ataxia in children, accounting for up to 32.5% of cases.[2] Ingestion associated with ataxia includes antihistamines, alcohol, anticonvulsants (especially phenytoin and carbamazepine), piperazine, diphenylhydantoin, barbiturates, carbon monoxide, organic solvents, and bromides.[11] Accidental ingestion occurs in young children. Adolescents can also present after ingestion in attempts to self-harm. Symptoms of ingestion can be nonspecifi c. Indeed, when symptoms do not fi t well into a clinical syndrome, ingestion should become a concern. When considering toxic ingestion, it is also important to evaluate for other evidence of metabolic aberrations, such as hypoglycemia, hyponatremia, and hyperammonemia. ## _**Common Causes of Ataxia**_ ## **Sensory or Motor Ataxia Caused by Guillain-Barr\u00e9 Syndrome**"
  },
  {
   "source": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll), p. 109",
   "text": "**Goldstein B, Giroir B, Randolph A:** International Consensus Conference on Pediatric Sepsis: International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. _Pediatric Critical Care Medicine_ 6:2\u20138, 2005. **Tieder JS, Bonkowsky JL, Etzel RA, et al:** Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. _Pediatrics_ 137(5):e20160590, 2016. ## **Websites (Accessed November 2016)** **Resuscitation Council (UK):** _Guidelines on Paediatric Life Support_ , London, 2015, Resuscitation Council. https://www.resus.org.uk 96 ![](/tmp/pdf-images/pdf-0110-00.png) ## **Accidents and poisoning** ## **Accidents 97** **Poisoning 103** Features of accidents and poisoning in children are: - [ accidental injury is the most common reason for ] children and young people to seek emergency healthcare"
  },
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 372",
   "text": "## **ALCOHOL, ETHYL (ETHANOL)** Alcoholic beverages, tinctures, cosmetics, mouthwashes, food extracts (vanilla, almond, etc.), rubbing alcohol, and hand sanitizers are common sources of poisoning in children. Alcohol is even available in powdered form for mixing and consumption. Concomitant exposure to other depressant drugs increases the seriousness of the intoxication. In most states, alcohol levels of 50\u201380 mg/dL are considered compatible with impaired faculties, and levels of 80\u2013100 mg/dL are considered evidence of intoxication. (Blood levels cited here are for adults; comparable figures for children are not available.) Recent erroneous information regarding hand sanitizers has indicated that a \u201click\u201d following application on the"
  },
  {
   "source": "Pediatrics for Practitioner (Sharad Thora), p. 158",
   "text": "- Industrial chemicals (7.9%). - Bites and stings (3.2%). - Plant and its derivatives (1.5%). ## **Symptoms and Signs of** ## **Common Poisoning** The symptoms and signs of common poisoning are depicted in Table 1. ## **Management** The principles of poisoning management (Flow chart 1) are: - Removal of the source of poison - Initial resuscitation and stabilization In children, accidental exposure (96.9%) is higher than the intentional attempts (3.1%). Peak incidence of accidental ingestion is in 2nd year of life and 85% of accidental poisoning affect children under 5 years of age. The common poisons reported in national database are: - Symptomatic and supportive measures - Removal of unabsorbed poisons \u25a0 From gastrointestinal tract (GIT) \u25a0 From skin, eye and other body cavities - Hastening the elimination of absorbed poisons - Use of specific antidote, if available. **138** Pediatrics for Practitioner ## **Table 1** ## **Symptoms and signs of common poisoning**"
  }
 ]
}