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Poisoning Basic Management in Children

Poisoning Basic Management

Evaluation
H/O drug/poison ingestion, inhalation, contamination etc from parents or care giver
Accidental or intentional,
Evidence from wound, odour, vomitus, opened bottle, containers.
Investigation
·         CBC
·         Urine.
·         Blood glucose.
·         LFTs.
·         ABG when possible and necessary.
·         Drug levels.
·         Chemical analysis of poison in vomitus, gastric aspirate.
·         X-ray Chest.
·         ECG.
(where indicated)

Management
General principles
Repot to CMO for medico legal purposes
Dangerous features needing urgent action
·         Coma
·         Convulsions
·         Shock
·         Bradypnea
·         Sepsis
·         Hypotension
·         Arrhythmia
·         Cyanosis

·         Coma: Keep airway patent, give oxygen, ambu bagging may be needed
·         Convulsions: IV diazepam (0.3mg/kg/dose, repeat 3 times)
·         Shock/ hypotension: raise foot end of the bed, push normal saline IV 20-30 ml/kg in 20 minutes.
·         Apnea/gasping or shallow breathing: ambu bagging.
·         Arrhythmias: for severe bradycardia (HR< 50/minute), give 0.01 mg/kg atropine IV stat, arrange ECG monitoring

Induction of vomiting: Induce vomiting in all cases brought within 6 hours of ingestion of poison unless contradicted:
·         Comatose patient
·         Corrosive poisoning
·         Kerosene oil or petroleum ingestion.
Methods
1.      Gagging: Make the child drink 1-3 glasses of plain water or milk. Do not give saline or warm water. Put index finger in the back of mouth/throat. Protect your finger from bite. Keep head low and face down.
2.      Syrup of Ipecac (not the liquid extract)10 ml followed by two glasses of water or milk. Shake the child up and down. If no vomiting, repeat syrup ipecac in 15-30 minutes. If still no vomiting, arrange for stomach wash.

Gastric Lavage
If emesis not achieved in 1/2 hr, do gastric lavage in all cases except in corrosive poisoning or when only small amount of kerosene oil taken.
Antidotes
·         Activated charcoal: effective against all poisons except cyanide. 2 table spoonfuls in 8ozs of water.
·         Universal antidore:
·         Activated charcoal                              two parts
·         Magnesium hydroxide                        one part
·         Tannic acid                                         one part
·          Burnt toast, milk of magnesia in equal amounts may be used as alternative.
·         Milk and white of egg especially in copper sulphate poisoning.
·         KMnO4 1:10,000 solution for opium.
·         Starch solution for iodine.
·         Calcium lactate 10% in lavage solution for chlorinated hydrocarbons, fluorides and oxalates.

·         Naloxone 0.1 mg/kg IV for opium and morphine poisoning. Repeat after every 3-5 minutes till response is achieved (pupillary dilation and improvement in respiration).
Removal of poison from circulation
·         Ample fluids orally or IV and diuretics, forced diuresis
·         Exchange transfusion.
·         Peritoneal dialysis.
·         Haemodialysis.
Other supportive measures
·         Fluid and electrolyte balance.
·         Correction of acid base status.
·         Management of renal failure.
·         Blood transfusion for anemia.
·         Treat fever and infections.
General nursing care including care of bowel and bladder.

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