1 / 75

Pediatric Toxicology

Pediatric Toxicology. Jana Stockwell, MD. Epidemiology. 2 million calls 52% of poison center calls <6years Peak ages: 18 months - 3 years. Epidemiology. Unintentional (1-2 years) Exploratory Boys > girls Unable to discriminate safe from unsafe liquid Intentional (adolescent)

gerik
Télécharger la présentation

Pediatric Toxicology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pediatric Toxicology Jana Stockwell, MD

  2. Epidemiology • 2 million calls • 52% of poison center calls <6years • Peak ages: 18 months - 3 years

  3. Epidemiology • Unintentional (1-2 years) • Exploratory • Boys > girls • Unable to discriminate safe from unsafe liquid • Intentional (adolescent) • Purposeful • Girls > boys

  4. Epidemiology • Around meal time • Grandparents home • Kerosene or gasoline in a soda bottle • Older sibling can pharmaceutically treat younger sibling

  5. Most often reported • Cleaning products 10% • Analgesics 10% • Cosmetics 9% • Cough & cold preparation 5% • Insecticides 4%

  6. PICU Admission • Tricyclic antidepressants (TCA) • Anticonvulsants • Digoxin • Opiates • Hydrocarbon-based household products

  7. Toxic Exposures  Death • Analgesics • Sedative-hypnotics • Alcohols • Gases & fumes • Cleaning substances

  8. “Fatal Sip” • Camphor (Vick’s VapoRub) 1000 mg/5 ml • (100mg/kg) • Methyl salicylate (wintergreen) 1400 mg/ml • (200 mg/kg) • Benzocaine (OraGel) • 2 mL • Met-hemoglobinemia • Seizure

  9. “Malignant Swallow” • Chloroquine (20 mg/kg) • Theophylline (8.4 mg/kg) • Imipramine (15 mg/kg) • Chlorpromazine (25 mg/kg) • Clonidine (0.3 mg tablet) • Bradycardia • CNS depression

  10. Other Highly Toxic • Acetonitrile - nail tip remover  MetHgb • Ammonium fluoride – hub cap cleaner (ArmorAll)  sz, arrhythmias, acidosis • Pennyroyal Oil – some herbal teas

  11. Albuterol Celebrex Oruvail Lamictal Lotrimin Plendil Hydralazine Hydrocodone Atenolol Cerebrex Elavil Lomotil Lotensin Pindolol Hydroxyzine Hydrocortisone Look-Alike, Sound-A-Like

  12. Poison plants • Digitalis effects • Lily-of-the-valley, Foxglove, Oleander, Yew • Nicotinic effects • Poison hemlock • Atropinic effects • Jimson weed

  13. Ball point ink Bubble bath soaps Chalk Cigarettes (< 3 butts) Crayons Deodorants Lipstick Pencil (graphite) Toothpaste Water colors Candle wax (but candle oil is!) Non-Toxic Products

  14. Evaluation • History of poisoning • Physical examination • Laboratory studies • Gastrointestinal decontamination

  15. History • What? • When? • How much? • Reliability…

  16. What ? • Medication • Illicit drug • Hazardous chemical

  17. What form? • Pill • Solid • Liquid • Gaseous

  18. What route ? • Ingestion • Inhalation • Topical • Intravenous

  19. When ? • Elapsed time

  20. How much ? • Estimate amount • Concentration

  21. “Clues”

  22. Bradycardia • Calcium channel blockers • Digoxin • Narcotics • Organophosphates • Carbon monoxide • Beta-blockers • Clonidine

  23. Tachycardia • Amphetamine (Ritalin) • Atropine • TCA’s • Theophylline • Salicylates (aspirin) • Iron • Cocaine • PCP • Synthroid

  24. Slow Respiration • Alcohol • Narcotics • Clonidine • Sedatives

  25. Tachypnea • Amphetamines • Salicylates • Carbon monoxide • Ethylene glycol (anti-freeze)

  26. Hypotension • Calcium channel blockers • Carbon monoxide • Cyanide • Iron • Narcotics • Anti-hypertensives • Met-hemoglobin

  27. Hypertension • OTC cold remedies • Amphetamine • PCP • TCA • Cocaine • Diet pills

  28. V Tach • Amphetamines • Carbamzepine (Tegretol) • Chloral hydrate • Cocaine • Digitalis • Theophylline

  29. Torsades de Pointes • Chloral hydrate • Cisapride • Organophosphates • Terfenadine • Phenothiazines

  30. Hypoglycemia (HOBBIES) • Hypoglycemia • Oral hypoglycemic agents • Beta-Blockers • Insulin • Ethanol • Salicylates

  31. Hypothermia • Ethanol • Narcotics • Carbon monoxide • Clonidine

  32. Hyperpyrexia • Atropine • Salicylates • Theophylline • Cocaine • TCA

  33. CNS - Coma • Narcotic • Anti-cholinergics • Carbon monoxide

  34. CNS - Delirium / Psychosis • Alcohol • PCP / marijuana • LSD

  35. CNS - Seizure • Cocaine • Amphetamine • Lead • Salicylate • Isoniazid • Theophylline

  36. Pupils - Miosis(COPS) • Cholinergics, Clonidine • Opiates, Organophosphates • Phenothiazine, Pilocarpine • Sedatives (barbiturates, ethanol)

  37. Pupils - Mydriasis(AAAS) • Anti-histamine • Anti-depressant • Anticholinergics (atropine) • Sympathomimetics • amphetamine, cocaine, PCP

  38. Caution! • Polydrug overdoses with opposite pupillary actions • Non-toxin diagnoses • Head trauma • CNS hemorrhage

  39. Cyanosis • MetHgb • Unresponsive to O2 • Aniline dyes • Nitrites • Benzocaine • Dapsone

  40. Dry Skin • Anticholinergic

  41. Breath Odors • Arsenic Garlic • Camphor Mothballs • Cyanide Bitter almond • Methyl salicylate Wintergreen • Paraldehyde Pears • Hemlock Carrots

  42. Toxidromes

  43. Cholinergic • “DUMBBELS” • “SLUDGE” Example – Organophosphates Nerve agents

  44. DUMBBELS • Diarrhea, diaphoresis • Urination • Miosis, muscle fasiculation • Bradycardia • Bronchospasm • Emesis • Lacrimation • Salivation

  45. SLUDGE • Salivation • Lacrimation • Urination • Diarrhea • GI complaint • Emesis

  46. Anti-cholinergic syndrome • Dry mouth • Flushed appearance • Dilated pupils • Fever • Ileus • Urinary retention • Disorientation Examples – Anti-histamines Jimson weed Lomotil TCA Carbamazepine Glycopyrrolate Atropine

  47. Anti-cholinergic • Hot as a hare • Blind as a bat • Dry as a bone • Red as a beet • Mad as a hatter • Full as a flask

  48. Narcotic • Pinpoint pupils • Coma • Respiratory depression

  49. Salicylates • Fever • Tachypnea & hyperpnea • Lethargy • Metabolic acidosis

  50. Theophylline • Protracted Vomiting • Tremors • Tachycardia • Seizures • Hypotension

More Related