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thiamine deficient secondary to eating disorders, chronic disease (e.g.,
inflammatory bowel disease), or alcoholism.
The rationale for decontamination (D econtamination) of the poisoned child is
discussed in the next section. This treatment phase may begin urgently, after or in
concert with attention to the ABCDs. At times, a decision to perform gastric
decontamination through the preferred technique can be made almost
immediately upon presentation and, if so, should be instituted as soon as possible,
taking into account the patient’s clinical status. For example, a toddler with coma,
shock, and massive hematochezia who is rushed into the ED by the rescue squad
—and for whom there is witnessed or strong circumstantial evidence of massive
iron overdose—requires a concerted team effort directed toward resuscitation,
stabilization, and urgent gastric decontamination. However, an asymptomatic
adolescent who ingests 10 g of acetaminophen 30 minutes before arrival at the
ED may be fully evaluated in a timely but orderly manner (as outlined in the next
section) and considered for less emergent gastric decontamination—in this case,
possibly an oral dose of activated charcoal. Significant dermal or ocular
exposures require immediate copious lavage, and precautions should be taken to
protect healthcare providers from exposure.
At the completion of this initial life support phase, the poisoned patient should
have been assessed for compromise of vital airway and cardiorespiratory function
and for global neurologic status and should have had resuscitative measures
instituted. Patients with significant altered mental status have been critically
evaluated for respiratory status, have had IV access secured, and have had
therapeutic trials of oxygen, glucose, and naloxone. Other advanced life support
interventions such as anticonvulsants or antiarrhythmics have been instituted as
necessary. Consideration of decontamination options has begun.

Evaluation and Detoxification Phase
History
A brief and focused historical evaluation should be addressed as soon as the life
support phase has been completed. The primary goal is to determine the potential

severity of the exposure, which requires information about both the poison and
the patient.
For a known or highly suspected toxic exposure, attempt to estimate the total
amount ingested (number of pills missing, ounces left in the bottle, dosage of
pills, concentration of alcohol, and so forth). Also attempt to determine the best
estimate of time elapsed since ingestion. Ask about early symptoms noted at
home or en route to the ED and any treatments administered before arrival.