What is the emergency management of acid poisoning in children?

Emergency Management of Acid Poisoning in Children

Do not give anything by mouth (no water, milk, or activated charcoal) unless specifically directed by poison control, and immediately remove contaminated clothing while irrigating exposed skin or eyes with copious amounts of water. 1

Immediate Actions and Stabilization

First Response Priorities

• Activate EMS immediately if the child exhibits any life-threatening signs including altered mental status, seizures, respiratory difficulty, or vomiting 1
• Contact Poison Control Center (1-800-222-1222 in the United States) immediately for specific guidance on systemic toxicity management 1
• Remove all contaminated clothing and jewelry to prevent continued exposure, ensuring you do not contaminate yourself in the process 1

Decontamination Protocol

• For skin exposure: Brush off any powdered chemicals with a gloved hand or cloth first, then immediately irrigate the affected area with copious amounts of water 1
• For eye exposure: Rinse eyes immediately with copious amounts of water (at least 15 minutes of continuous irrigation) 1
• Use warmed water for pediatric decontamination to prevent hypothermia, and apply lower pressure to prevent additional skin damage 1
• In cold climates: Use heat lamps, blankets, and other warming mechanisms to prevent hypothermia during decontamination 1

Critical "Do Not" Actions

Contraindicated Interventions

• Do not administer anything by mouth (water, milk, or activated charcoal) unless specifically advised by poison control center or emergency medical personnel, as it may cause emesis and aspiration 1, 2, 3
• Do not induce vomiting or administer ipecac, as it is contraindicated and provides no clinical benefit while potentially causing harm 2, 3
• Do not attempt dilution with water or milk, as no human studies demonstrate clinical benefit and administration may cause vomiting and aspiration 1, 2
• Do not waste time trying to remove ingested substances with abdominal or chest thrusts 1

Airway, Breathing, and Circulation Management

Life Support Measures

• Maintain airway patency and support breathing as the first priority in life-threatening situations 4
• Place unconscious patients in the left lateral head-down position 4
• Implement resuscitation for cardiorespiratory arrest if needed 4
• Monitor for respiratory depression and provide respiratory support if necessary 4

Pediatric-Specific Considerations

• Children have higher minute ventilation and less fluid reserves, making them more susceptible to toxic effects 1
• Children dehydrate more quickly following vomiting and diarrhea, requiring careful fluid management 1
• Cardiac output is rate-dependent in children, necessitating continuous hemodynamic monitoring 1

Clinical Monitoring and Assessment

Expected Toxicity Patterns

• Central nervous system effects: drowsiness, dizziness, agitation, altered consciousness, seizures, or coma 2, 4
• Gastrointestinal manifestations: sore throat, mucosal irritation, vomiting 2
• Respiratory complications: difficulty breathing, respiratory depression 1
• Cardiovascular effects: tachycardia, altered peripheral pulse volume, cool peripheries, prolonged capillary refill time 1

Ongoing Assessment

• Continuous monitoring is essential as some substances can have delayed effects 4
• Evaluate for multi-organ toxicity requiring intensive supportive care 2
• Assess for signs of shock: hypotension, prolonged capillary refill (≥2 seconds), altered consciousness 1

Hospital Management Considerations

Indications for Hospital Admission

• Potentially severe poisoning with life-threatening signs or symptoms 4
• Unknown dose of potentially lethal substance 4
• Patients at increased risk or those who have taken substances with delayed effects 4
• Intentional ingestion requiring evaluation for suicide risk and psychological distress 4

Advanced Interventions (Hospital Setting)

• Activated charcoal may be considered in the hospital setting for specific substances if the patient is fully conscious and capable of swallowing safely, preferably within 2 hours of ingestion 4
• Extracorporeal treatment (hemoperfusion, therapeutic plasma exchange) may be indicated for severe poisoning cases 5
• Specific antidotes should be administered only when indicated for confirmed exposures 4

Common Pitfalls to Avoid

• Do not delay EMS activation while attempting home interventions 1
• Do not assume dilution helps—this is not evidence-based and may worsen outcomes 1, 2
• Do not overlook hypothermia risk during decontamination in pediatric patients 1
• Do not contaminate yourself while removing the child's clothing or during decontamination 1
• Do not rely on gastric emptying procedures—these are rarely indicated and carry significant risks 4