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adolescent and adult exposures. The most important difference between the
pediatric and the adult profile by type of agent is in the higher percentage of cases
in which psychopharmacologic drugs (sedatives, tranquilizers, and
antidepressants) cause poisoning in adults and the much higher frequency of
exposures to household and personal care products and plants in children.
There are seven basic routes of poison exposure: oral (ingestion), ocular,
dermal, inhalational, transplacental, parenteral, and by envenomation. Poisonings
may result from acute or chronic exposures. Most poisonings treated in EDs are
acute, typified by the curious child who gains access to a medication or household
cleaning product, or the suicidal adolescent who takes a polypharmaceutical
overdose. Chronic poisoning refers to toxicity which develops over time as a
substance accumulates in the body, and is best exemplified by environmental
exposure to lead or other heavy metals. Chronic pharmaceutical toxicity also
occurs. Examples include acetaminophen hepatotoxicity in infants and small
children after repeated supratherapeutic dosing, or aspirin poisoning in older
adults with excessive dosing or renal impairment. Chronic toxicity can be a
challenging diagnosis because the source is not always apparent, the toxicity is
not always clear, and the toxic process is not often obvious until serious clinical
derangements occur. In addition, serum drug levels do not accurately reflect
toxicity risk in chronic or acute-on-chronic exposures.