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Toxic ingestions in children

Last reviewed: 30 Sep 2024
Last updated: 13 Feb 2024

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 misuse
  • sympathomimetic toxidrome
  • antimuscarinic toxidrome
  • opioid toxidrome
  • sedative-hypnotic toxidrome
  • cholinergic toxidrome
Full details

Other diagnostic factors

  • nausea, vomiting, or diarrhea
  • 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 hypoglycemia
  • jaundice
  • hyperreflexia and myoclonus
  • muscle rigidity
  • nystagmus
  • ataxia
  • stridor
Full details

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
Full details

Diagnostic tests

1st tests to order

  • serum electrolytes
  • serum BUN
  • serum creatinine
  • fingerstick or serum glucose
  • capillary blood gas or ABG
  • anion gap
  • serum lactate
  • serum ketones or acetone
  • INR
  • LFTs
  • serum acetaminophen levels
  • serum salicylate levels
  • urine drug screen
  • urinalysis
  • ECG
  • pregnancy test
  • serum creatine kinase
  • abdominal x-ray
  • chest x-ray
Full details

Tests 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
Full details

Treatment algorithm

ACUTE

asymptomatic

symptomatic and/or high-risk ingestion and/or elevated drug levels

Contributors

Authors

David L. Eldridge, MD

Associate Professor of Pediatrics

Senior Associate Dean of Academic Affairs

Brody School of Medicine at East Carolina University

Greenville

NC

Disclosures

DLE has received research grants and been a site investigator for a closed clinical trial from GlaxoSmithKline and a closed clinical trial from Cempra Pharmaceuticals. DLE is an author of two of the references cited in this topic.

Matthew R. Ledoux, MD

Chair, Department of Pediatrics

Pediatrician in Chief Maynard Children's Hospital

Associate Professor of Pediatrics

Maynard Distinguished Scholar of Pediatrics

Brody School of Medicine at East Carolina University

ECU Health

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.

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