Summary
Definition
History and exam
Key diagnostic factors
- error de medicamentos en lactantes
- ingestión presenciada o niño encontrado con un frasco vacío o un comprimido
- antecedentes de ingestión deliberada
- antecedentes de toxicomanía
- toxindrome simpaticomimético
- toxindrome antimuscarínico
- toxindrome opioide
- toxindrome hipnótico-sedante
- toxindrome colinérgico
Other diagnostic factors
- náuseas, vómitos o diarrea
- alteración del estado mental
- fiebre e hipertermia
- coloración o quemaduras en la boca y la orofaringe
- hipertensión o hipotensión
- hiperventilación o hipoventilación
- convulsiones
- ceguera o disminución de la visión
- disminución de la audición o acúfenos
- coloración rojiza de la piel
- síntomas y signos de hipoglucemia
- ictericia
- hiperreflexia y mioclono
- rigidez muscular
- nistagmo
- ataxia
- estridor
Risk factors
- presencia de medicamentos en el hogar
- fácil acceso a medicamentos o productos químicos de uso doméstico
- edad temprana
- pica
- estrés emocional
- antecedentes de depresión u otras enfermedades mentales
- sexo femenino
- antecedentes familiares de trastorno por consumo de alcohol
Diagnostic tests
1st tests to order
- electrolitos séricos
- urea sérica
- creatinina sérica
- glucosa sérica o punción dactilar
- gasometría capilar o gasometría arterial (GSA)
- anión gap
- lactato sérico
- cetonas séricas o acetonas
- Índice internacional normalizado (INR)
- pruebas de función hepática (PFH)
- niveles séricos de paracetamol
- niveles séricos de salicilato
- cribado de tóxicos en orina
- análisis de orina
- electrocardiograma (ECG)
- prueba de embarazo
- creatina-cinasa sérica
- radiografía de abdomen
- radiografía de tórax
Tests to consider
- nivel de etanol
- niveles séricos de metanol o etilenglicol
- nivel sérico de digoxina
- niveles séricos de anticonvulsivos
- niveles séricos de hierro
- niveles séricos de litio o teofilina o niveles de metales pesados en sangre total
- cribado integral de fármacos en orina
- protocolo terapéutico de la naloxona
- protocolo terapéutico del bicarbonato sódico
- protocolo terapéutico de la atropina y la pralidoxima
- protocolo terapéutico del flumazenil
- protocolo terapéutico del octreótido
- protocolo terapéutico de la fisostigmina
Treatment algorithm
asintomático
ingestión sintomática y/o de alto riesgo y/o niveles del fármaco elevados
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.
References
Key articles
Hoffman RS, Burns MM, Gosselin S. Ingestion of caustic substances. N Engl J Med. 2020 Apr 30;382(18):1739-48.
McKay C. Can the laboratory help me? Toxicology laboratory testing in the possibly poisoned pediatric patient. Clin Pedi EM. 2005;6:116-22.
Dart RC, Goldfrank LR, Erstad BL, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2018 Mar;71(3):314-25.e1.Full text Abstract
Royal College of Emergency Medicine. College of Emergency Medicine and National Poisons Information Service guideline on antidote availability for emergency departments, 2021 update. Dec 2021 [internet publication].Full text
American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. Position paper: single-dose activated charcoal. Clin Toxicol (Phila). 2005;43(2):61-87.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Causas no tóxicas de la taquicardia de complejo ancho
- Estado epiléptico por causas no tóxicas
- Causas no tóxicas de una acidosis metabólica con anión gap
More DifferentialsGuidelines
- Expert consensus for a national essential antidote list: e-Delphi method
- Guideline on antidote availability for emergency departments
More Guidelines
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