Management of Common Poison Intake in Children
The initial management of a child with suspected poison intake should focus on immediate stabilization, followed by specific antidotes based on the identified toxin, with supportive care as the cornerstone of treatment. 1
Initial Assessment and Stabilization
- Immediately establish an open airway and provide bag-mask ventilation if respiratory compromise is present, followed by endotracheal intubation when appropriate 1
- Position unconscious patients in the left lateral head-down position to prevent aspiration 2
- For life-threatening situations, call an emergency response mobile unit and implement life-support techniques 2
- Contact a poison control center (1-800-222-1222) for assistance with diagnosis, prognosis, and management guidance 1, 3
Decontamination Strategies
Activated Charcoal
- Administer activated charcoal as soon as possible, preferably within 2 hours after ingestion of substances known to be adsorbed by it 2
- Only give if the patient is fully conscious and capable of swallowing safely 2
- Should be considered as an alternative to removal of gastric contents when emesis is contraindicated 4
Gastric Decontamination
- Ipecac syrup should NOT be used as a first aid treatment for acute poisoning 1, 2
- Gastric lavage carries a risk of serious adverse effects and is only justified in rare cases where the patient's life is at risk following ingestion of a drug not adsorbed by activated charcoal 2
- There is insufficient evidence for administering diluents (such as milk or water) for caustic substance ingestion 1
Specific Antidotes for Common Poisonings
Benzodiazepine Poisoning
- For respiratory depression/arrest caused by suspected combined opioid and benzodiazepine poisoning, administer naloxone first before other antidotes 1
- Flumazenil (0.01 mg/kg in children) can be effective in select patients with pure benzodiazepine poisoning who don't have contraindications 1
- Avoid flumazenil in patients with benzodiazepine dependence, seizure disorders, or when cyclic antidepressant co-ingestion is suspected due to risk of seizures and dysrhythmias 1
Opioid Poisoning
- Administer naloxone 0.1 mg/kg IV/IO/IM for children with respiratory depression 1
- Titrate to reversal of respiratory depression and restoration of protective airway reflexes 1
- Monitor closely as naloxone's duration of action is often shorter than that of opioids 2
Acetaminophen Poisoning
- Administer activated charcoal as soon as possible 2
- Give acetylcysteine within 24 hours after ingestion to protect the liver 2
- Consider acetylcysteine when emergency medical intervention is not feasible within 8-10 hours after ingestion 2
Other Common Poisonings
- For organophosphate poisoning: Atropine 0.02 mg/kg, doubled every 5 minutes, titrated to reversal of bronchorrhea, bronchospasm, bradycardia, and hypotension 1
- For carbon monoxide poisoning: Administer 100% oxygen immediately 1
- For methemoglobinemia: Consider methylene blue 1-2 mg/kg 1
Monitoring and Disposition
- Hospital monitoring is warranted for potentially severe poisoning, including patients at increased risk or those who have taken a potentially lethal substance at a toxic or unknown dose 2
- Consider the risk of delayed effects with certain substances and formulations 2
- For intentional poisoning, evaluate the risk of short-term relapse and consider hospital admission until the acute risk of suicide has subsided 2
Special Considerations for Children
- The highest incidence of poisoning occurs in children aged 1-3 years (unintentional) and 12-18 years (often voluntary) 5
- Most pediatric poisonings occur at home (70.4%) and by ingestion (87.1%) 5
- Warm shower water should be used for decontamination to avoid hypothermia, and at lower pressure to prevent additional skin damage 1
- In cold climates, use heat lamps and blankets to prevent hypothermia during decontamination 1