Approach

Children may present in one of two ways. Some children are asymptomatic on presentation and present because they have claimed or are suspected to have taken an overdose or ingested a poison. Other children present with symptoms of acute poisoning. These may include non-specific findings such as altered mental status, seizures, or abnormal vital signs. There may be historical clues such as time to seeking care, patterns of behaviour, and type of ingestion that may lead a practitioner to suspect intentional rather than unintentional poisoning.

An overdose or poison ingestion in a child is a clinical diagnosis supported by laboratory findings. In accidental ingestions, it is often possible to use targeted investigations if the identity of the ingested substance is known, or if the range of possible ingested substances is narrow. However, if the identity of the substance is not known, or the ingestion was deliberate, testing should be broad in order to identify all ingested substances. Toxicologists and laboratory experts have developed a list of recommended diagnostic tests that should be available to healthcare workers treating a poisoned child. These specific tests should be performed in all patients to identify the ingested toxins.[12]

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