Pediatric emergency medicine trisk 3024 3024

exploratory exposures to poisons make up 80% to 85% or more of all reports,
whereas intentional poisonings comprise the other 10% to 15%. Persons in this
latter group have much higher rates of treatment in the ED, hospitalization, and
intensive care. Among children 5 years and younger, most poisoning exposures
are related to exploratory behavior. Although less common, the physician must
also consider the possibility of environmental exposures, therapeutic errors,
suicide attempts in children, and neonates exposed to toxicants in utero. Child
abuse by poisoning, while rare, should be suspected in patients outside the typical
age for self-poisoning (e.g., <1 year, 5 to 11 years of age), when multiple agents
or illicit drugs are involved, when siblings present with similar syndromes, and in
cases of massive ingestions in a young child.
The exploratory toxic ingestion by a toddler represents a complex interplay of
host, agent, and environmental factors and may be considered a subset of the
modern traumatic injury model, in which each factor contributes more or less to
the probability of injury. Some children are more at risk because of peak age of 1
to 4 years, male gender, hyperactivity, and increased finger–mouth activity and/or
pica. Some agents are more culpable because of ease of access,
attractiveness/palatability, and toxic potential. Two classic examples are iron
tablets, which may look like candy, are widely available, and are toxic in
significant overdose; and mouthwash, which has a bright color, as well as a
pleasant taste and smell, is often packaged in large volumes without child-safety
caps, and may have surprisingly high ethanol content of 15% to 25%. Typical
environmental factors include an acute stressor, such as a recent move or new
baby in the household, or more chronic issues, such as parental illness/disability.
Pediatricians have led the way in poisoning prevention strategies by modifying
these risk factors with traditional anticipatory guidance and spearheading the
campaign for child-resistant closures on particularly dangerous medications and
household products. These efforts resulted in a dramatic decrease in childhood
poisoning morbidity and mortality since the 1970s, but recent data suggest a
worrisome trend. As prescribing patterns in the adult population have created an
increased availability of potentially hazardous medications, particularly opioids,

there has been an increase in serious pharmaceutical exposures in young children.
The scope of toxic substances involved in poisonings is broad, requiring a wide
range of knowledge. Tables 102.1 and 102.2 review the categories of substances
most commonly reported in human exposures in the United States for the year
2017. Table 102.3 presents the most common toxic exposures involved in human
deaths for the year 2017. The former listing much more closely approximates the
profile of pediatric poisonings, whereas the latter is more typical of intentional