Toxic ingestions in children
Summary
Definition
History and exam
Key diagnostic factors
- medication error in infants
- witnessed ingestion or child found with empty bottle or pill
- history of deliberate ingestion
- history of substance abuse
- sympathomimetic toxidrome
- antimuscarinic toxidrome
- opioid toxidrome
- sedative-hypnotic toxidrome
- cholinergic toxidrome
Other diagnostic factors
- nausea, vomiting, or diarrhoea
- altered mental status
- fever or hyperthermia
- staining or burns of the mouth and oropharynx
- hypertension or hypotension
- hyperventilation or hypoventilation
- seizures
- blindness or reduced vision
- reduced hearing or tinnitus
- reddened skin coloration
- symptoms and signs of hypoglycaemia
- jaundice
- hyperreflexia and myoclonus
- muscle rigidity
- nystagmus
- ataxia
- stridor
Risk factors
- presence of medications in the household
- easy access to medications or household chemicals
- young age
- pica
- emotional stress
- history of depression or other mental illness
- female sex
- family history of alcohol use disorder
Diagnostic investigations
1st investigations to order
- serum electrolytes
- serum urea
- serum creatinine
- fingerprick or serum glucose
- capillary blood gas or ABG
- anion gap
- serum lactate
- serum ketones or acetone
- INR
- LFTs
- serum paracetamol levels
- serum salicylate levels
- urine drug screen
- urinalysis
- ECG
- pregnancy test
- serum creatine kinase
- abdominal x-ray
- chest x-ray
Investigations to consider
- ethanol level
- serum methanol or ethylene glycol
- serum digoxin level
- serum anticonvulsant levels
- serum iron levels
- serum lithium, theophylline, or whole blood heavy metal levels
- comprehensive urine drug screen
- therapeutic trial of naloxone
- therapeutic trial of sodium bicarbonate
- therapeutic trial of atropine and pralidoxime
- therapeutic trial of flumazenil
- therapeutic trial of octreotide
- therapeutic trial of physostigmine
Treatment algorithm
asymptomatic
symptomatic and/or high-risk ingestion and/or elevated drug levels
Contributors
Authors
David L. Eldridge, MD
Associate Professor
Clerkship Director
Department of Pediatrics
Brody School of Medicine at East Carolina University
Greenville
NC
Disclosures
DLE has received research grants and been a site investigator for an ongoing clinical trial from GlaxoSmithKline and a closed clinical trial from Cempra Pharmaceuticals. DLE is an author of one reference cited in this topic.
Matthew R. Ledoux, MD
Associate Professor of Pediatrics
Vice Chair of Pediatrics
Co-Medical Director, Maynard Children’s Hospital, Vidant Medical Center
Division Chief, Division of Pediatric Critical Care and Hospital Medicine
Department of Pediatrics
Brody School of Medicine at East Carolina University
Greenville
NC
Disclosures
MRL declares that he has no competing interests.
Acknowledgements
Dr David Eldridge and Dr Matthew Ledoux would like to gratefully acknowledge Dr Cynthia K. Aaron and Dr Keenan M. Bora, previous contributors to this topic.
Disclosures
CKA and KMB declare that they have no competing interests.
Peer reviewers
Laurie Prescott, MD, FRCP
Emeritus Professor of Clinical Pharmacology
Faculty of Medicine
University of Edinburgh
Edinburgh
UK
Disclosures
LP declares that he has no competing interests.
Mark Mannenbach, MD
Consultant in Pediatric Emergency Medicine
Assistant Professor of Pediatric and Adolescent Medicine
Mayo Clinic College of Medicine
Rochester
MN
Disclosures
MM declares that he has no competing interests.
Colin A. Graham, MBChB, MPH, MD, FRCSEd, FRCSGlasg, FIMCRCSEd, FCCP, FCEM, FHKCEM, FHKAM
Editor
European Journal of Emergency Medicine
Professor of Emergency Medicine
Chinese University of Hong Kong
Hong Kong
People's Republic of China
Disclosures
CAG is the editor of the European Journal of Emergency Medicine and receives an annual honorarium from Wolters Kluwer Health, the journal's publishers.
Differentials
- Non-toxic causes of wide complex tachycardia
- Non-toxic causes of status epilepticus
- Non-toxic causes of anion gap metabolic acidosis
More DifferentialsGuidelines
- Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care
- Royal College of Emergency Medicine and National Poisons Information Service guideline on antidote availability for emergency departments
More Guidelines
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