{
 "topic": "Toxic Ingestion",
 "slug": "toxic-ingestion",
 "category_id": 15760,
 "passage_count": 14,
 "source_chars": 11393,
 "enough_material": true,
 "references": [
  {
   "title": "Berkowitz's Pediatrics",
   "author": "Berkowitz, Carol D.;",
   "pages": [
    616,
    617
   ]
  },
  {
   "title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "author": null,
   "pages": []
  },
  {
   "title": "Cover",
   "author": "Vitalsource Download",
   "pages": [
    3532,
    4736
   ]
  },
  {
   "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": "Algorithms in Pediatrics",
   "author": null,
   "pages": [
    195
   ]
  },
  {
   "title": "Pediatric Nutrition (Ronald E. Kleinman, Frank R. Greer)",
   "author": null,
   "pages": [
    818
   ]
  },
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    2242
   ]
  }
 ],
 "passages": [
  {
   "source": "Berkowitz's Pediatrics, p. 617",
   "text": "## **Differential Diagnosis** The differential diagnosis of toxic ingestions is broad. For the patient with a history of ingestion, the differential diagnosis is narrowed to substances available to the child. If no history of ingestion is given, the physician should include ingestion in the differential diagnosis when evaluating symptoms and signs such as altered mental status, altered behavior, metabolic derangement, cardiac dysrhythmia, hypotension and shock states, seizure, respiratory distress or apnea, cyanosis, vomiting, and diarrhea (Box 82.1). In fact, almost any symptom complex may result from a toxic ingestion. **Box 82.1. Symptoms of Toxic Ingestion** w Bradycardia or tachycardia w Hypothermia or hyperthermia w Respiratory depression or hyperpnea w Hypotension or hypertension w Mydriasis or miosis w Altered mental status or abnormal behavior w Seizure w Cardiac dysrhythmia w Metabolic derangement w Nausea, vomiting, diarrhea ## **Evaluation**"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Caustic ingestion is the leading toxic exposure in children, and can cause devastating injury to the esophagus and stomach with dire consequences. The most frequent exposures in children are to mild alkali agents such as household bleach and detergents, some of which can be relatively benign. Button battery ingestions in children are increasingly common and can be extremely dangerous (see Chapters 91 Gastrointestinal Emergencies and 118 ENT Emergencies for a full discussion ). The age distribution of pediatric ingestions is bimodal, with accidental ingestions common in children younger than 5 years and suicide attempts more common in teenagers and young adults. The extent and severity of injury depends on the type, concentration, and quantity of the ingested agent, as well as the duration of exposure. Liquid agents typically cause more injury than solids, with strong alkalis being associated with very severe damage. Following the initial ingestion of an acid or alkali, a significant inflammatory response"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Toxic Ingestions Pediatric toxic ingestions are often unwitnessed and are usually complicated by the young patient\u2019s inability to provide information on the quantity or identity of the substance ingested (see Chapter 102 Toxicologic Emergencies ). Table 17.2 lists many drug classes that cause coma with overdose. Exogenous toxins may impair neuronal function directly or by causing hypoxia, acidosis, enzyme inhibition, hypoglycemia, or seizures. ALOC can occur after direct intrathecal injection of medication such as baclofen resulting from intrathecal pump malfunction. Metabolic Alterations"
  },
  {
   "source": "Cover, p. 4736",
   "text": "## **CLINICAL MANIFESTATIONS** Children with toxoplasma infections can present with one of the following clinical scenarios: (1) postnatally acquired acute _Toxoplasma_ infection; (2) chronic latent _Toxoplasma_ infection; (3) reactivation of chronic latent _Toxoplasma_ infection in immunocompromised children, particularly in the absence of appropriate anti- _Toxoplasma_ prophylaxis; (4) ocular toxoplasmosis in an infant with CT, from reactivation of eye disease later in life in congenitally infected infants or during a postnatally acquired acute infection; and (5) CT in newborns or young infants. [Figure OCR, page 4736, figure 1] Risk of Congenital Infection (%) 8 8 g & nm o 1 o L \u2014 Risk ---- 95% Cl 0 4 8 12 16 20 24 28 32 36 4 Gestation at Maternal Seroconversion (Weeks) ## **Postnatally Acquired Acute** _**Toxoplasma**_ **Infection**"
  },
  {
   "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": "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": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "History of Toxic Ingestions If no history or physical examination findings suggestive of head trauma or seizures are present, a toxic ingestion should be considered, especially in toddlers and adolescents. The availability of any substances capable of depressing CNS function should be thoroughly explored. In general, coma from toxic ingestions is of slower onset than that from trauma and may be preceded by delirium or other abnormal behaviors."
  },
  {
   "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": "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": "Cover, p. 3532",
   "text": "## **PATHOGENESIS AND EPIDEMIOLOGY** Many enteric pathogens cause gastrointestinal (GI) infections in children, especially in those less than 5 years of age ( **Table 231-1** ). These pathogens are acquired via the fecal-oral route directly from another person or indirectly following ingestion of food or water contaminated with feces. Person-to-person transmission generally requires only a low-dose inoculum to produce infection and has a short incubation period. ## **TABLE 231-1 COMMON AGENTS CAUSING GASTROINTESTINAL INFECTIONS IN CHILDREN** ![](/tmp/pdf-images/pdf-3533-00.png)"
  },
  {
   "source": "Algorithms in Pediatrics, p. 195",
   "text": "## **ETIOPATHOGENESIS** Common causes of poisoning in India vary geographically and are dependent on access to various agents. Healthcare providers should be familiar with common poisonings in their area. ## **CLINICAL PRESENTATION** Most children present with nonspecific symptoms such as nausea, vomiting, or altered sensorium. However, there are certain toxidromes, which, on recognition, can give us a clinical diagnosis (Tables 1 and 2). ## **MANAGEMENT OF POISONING** ## **Initial Assessment and Emergency Management** In a responsive patient, initial management in all patients presenting to the emergency is focused on airway, breathing, and circulation. ## **Airway**"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "The exploratory toxic ingestion by a toddler represents a complex interplay of host, agent, and environmental factors and may be considered a subset of the modern traumatic injury model, in which each factor contributes more or less to the probability of injury. Some children are more at risk because of peak age of 1 to 4 years, male gender, hyperactivity, and increased finger\u2013mouth activity and/or pica. Some agents are more culpable because of ease of access, attractiveness/palatability, and toxic potential. Two classic examples are iron tablets, which may look like candy, are widely available, and are toxic in significant overdose; and mouthwash, which has a bright color, as well as a pleasant taste and smell, is often packaged in large volumes without child-safety caps, and may have surprisingly high ethanol content of 15% to 25%. Typical environmental factors include an acute stressor, such as a recent move or new baby in the household, or more chronic issues, such as parental illness/disability."
  },
  {
   "source": "Pediatric Nutrition (Ronald E. Kleinman, Frank R. Greer), p. 818",
   "text": "Pediatric Nutrition, 8th Edition Table 27.1. ## **Chronic Diarrhea in Childhood** ## **Diarrhea Without Failure to Thrive** Functional diarrhea Irritable bowel syndrome\u2014diarrhea predominant Substrate-induced diarrhea - Excessive juice - Disaccharide intolerance: lactose, sucrose - Laxative use - Caregiver-induced (Munchausen by proxy) - Infectious enteritis[a] - Parasitic: _Giardia, Strongyloides, Cryptosporidium, Cyclospora_ species - Bacteria: _Salmonella, Yersinia, Aeromonas, Plesiomonas_ species - Small-bowel bacterial overgrowth Overflow diarrhea from constipation ## **Diarrhea With Growth Failure/Malnutrition** Pancreatic insufficiency-steatorrhea - Cystic fibrosis - Shwachman-Diamond syndrome Disorders of lipid digestion, absorption, or transport - Abetalipoproteinemia - Chylomicron retention disease - DGAT1 deficiency - Intestinal lymphangiectasia Enterocyte structural disorders - Microvillus inclusion disease - Tufting disease"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2242",
   "text": "INFANT CHILD ADOLESCENT<br>ACUTE<br>Common<br>Gastroenteritis (viral > bacterial > protozoal) Gastroenteritis (viral > bacterial > protozoal) Gastroenteritis (viral > bacterial > protozoal)<br>Systemic infection Food poisoning Food poisoning<br>Antibiotic associated Systemic infection Antibiotic associated<br>Overfeeding Antibiotic associated<br>Rare<br>Primary disaccharidase deficiency Toxic ingestion Hyperthyroidism<br>Hirschsprung toxic colitis Hemolytic uremic syndrome Appendicitis<br>Adrenogenital syndrome Intussusception<br>Neonatal opiate withdrawal<br>CHRONIC<br>Common<br>Postinfectious secondary lactase deficiency Postinfectious secondary lactase deficiency Irritable bowel syndrome<br>Cow\u2019s milk or soy protein intolerance (allergy) Irritable bowel syndrome Inflammatory bowel disease<br>Chronic nonspecific diarrhea of infancy Celiac disease Lactose intolerance<br>Excessive fruit juice (sorbitol) ingestion Cystic fibrosis Giardiasis<br>Celiac disease Lactose intolerance Laxative abuse (anorexia"
  }
 ]
}