1. POISONING IN CHILDREN  Nearly always accidental  Common once:  kerosene  Cleaning agents  CO  Prescription medication

2. Always kept in mind even in absence of history of poisoning

3. Basics :  Confirm  Identify quality  Route & quantity  Time  Illness or drugs before

4. possible features :  Coma  Convulsion  Arrhythmias  GI symptoms  Acidosis  Odor  Color  sweating  Dryness  Gray cyanosis  Eye changes  Fever

5. Investigations  Blood counts, gases & osmolality  ECG  Chest & abdominal x-ray  Toxicology

6. Management  ABC & IV access  Monitoring  Removal  cleaning  Lavage  Ipecac  Charcoal  Antidote

7. Prevention 1)Protection of the child by: X child reach places X wrong containers child proof packing 2) Parent education  potential household poisons  Toddler supervision  Information's on management

8. KEROSENE POISONING  Most common here & least common elsewhere  Affects lungs & CNS  Both vomiting induction & lavage are contraindicated  Charcoal is not effective  ? Steroid & antibiotic

9. PARACETAMOL POISONING More than 150mg/kg is hepatotoxic Clinical stages  Day 1: GI symptoms  Day 2: rising TSB,SGOT,SGPT & PT  Day 3,4&5: peak hepatotoxicity  Day 6&7: possible recovery Treatment ; charcoal & NAC

10. TRICYCLIC ANTIDEPRESSANTS POISONING  Cardiac effects  CNS effects  Anticholinergic effects Treatment;  Lavage  Charcoal  Treat convulsion  Treat cardiac effects:  IV normal saline  Induce alkalemia  Lidocaine  Defibrillation

11. IRON POISONING More than 40mg/kg is toxic Toxic effects on;  GI  CVS  CNS  Metabolic  Liver

12. Iron poisoning (continued) Clinical phases:  Phase 1 (1 st 6hr.) : bloody diarr. & abd. Pain  Phase 2 (6-24hr.s): apparent recovery  Phase 3 (24-48r.s): shock,acidosis,convulsion, liver affection  Phase 4 (4-6weeks): GI stricture, hepatotoxicity

13. Iron poisoning (continued) Treatment:  GI decontamination  General supportive care  Chelation  Dialysis  Exchange transfusion

14. CAUSTIC POISONING Acids……….coagulation necrosis Alkalis……..liquefaction necrosis Drooling, stridor, dysphagia & erythema -+ ulceration Treatment: Irrigate No induction of vomiting Oral dilute milk or water ? Steroid Esophagoscopy

15. SALICYLATE POISONING More than 150mg/kg is toxic Respiratory alkalosis…………metabolic acidosis Tinnitus,fever,coma & circulatory collapse Treatment:  Lavage up to 4hours  Charcoal  Fluid & electrolyte  Vitamin K, ? Blood, FFP & clotting factors  Forced alkaline diuresis  Hemodialysis

16. CO POISONING Causes cellular anoxia by: o Displacing O2 on Hb o Shifting to left causes decrease O2 delivery at tissues o Affecting function of intracellular cytochrome oxidase

17. CO poisoning ( continued) Other effects:  Bronchopulmonary  CNS  Cardiac  Muscles  Skin

18. CO poisoning ( continued) Treatment: 100% O2 under pressure 5 hr. in room air 1 hr. in 100% O2 30 min. in 100% O2 under pressure

19. SMOKE INHALATION Causes upper airway burn( hot smoke) & cellular hypoxia ( from bronchopneumonia, CO & cyanide) Treatment: ETT, O2 & Na thiosulfate

20. LEAD POISONING  Paint  batteries  printing  Surma  Pica Encephalopathy, bone lines, resistant anemia Treatment:  Removal of source  Decontamination  Chelation( BAL)