Pediatric emergency medicine trisk 3023 3023

CHAPTER 102 ■ TOXICOLOGIC EMERGENCIES
MADELINE H. RENNY, KATHERINE A. O’DONNELL, DIANE P. CALELLO

PEDIATRIC POISONINGS
CLINICAL PEARLS
Poisoning in the young child is usually exploratory and more likely to
involve household products, whereas adolescents more commonly are
intentionally self-poisoned by pharmaceuticals or drugs of abuse.
Initial stabilization of a poisoned patient with altered mental status, in
addition to standard resuscitation measures, may include blood glucose
determination and empiric naloxone therapy.
Naloxone dosing can be higher in young children without concern for
opioid withdrawal, from 0.4 to 2 mg initially. In adolescents with concern
for chronic opioid use, a much smaller initial dose of 0.04 mg is
appropriate.
Consultation with the regional poison control center can be extremely
helpful in managing the poisoned child. In the United States, a single
phone number, 1-800-222-1222, will reach the nearest center.
Standard urine toxicology screens are seldom essential to evaluate
poisoned patients. The history and focused physical examination are
more valuable to determine the nature of exposure in the majority of
cases.
Pertinent diagnostic evaluation in the unknown exposure patient may
include serum chemistries, blood gas analysis, serum osmolarity, an
electrocardiogram, and quantitative serum acetaminophen, salicylate,
and ethanol concentrations.

Current Evidence
Poisoning represents one of the most common medical emergencies encountered
by young children and accounts for a significant fraction of emergency
department (ED) visits in the adolescent population.

Estimates of poisoning episodes annually in the United States range in the
millions. Poisonings may be unintentional or intentional. Unintentional or