So let’s go through some of the common
overdoses and poisonings in children
and how we manage them
and what we worry about.
Let’s start with aspirin.
Aspirin toxicity is a very
unique pathologic toxicity
with very unique presentation.
Aspirin can cause fever.
This is through uncoupling
This can also result in
a metabolic acidosis.
Additionally, aspirin has a central effect
on the brain which causes
a primary tachypnea and a
So they can get both first
a respiratory alkalosis a
and then a metabolic acidosis as a
result of their aspirin toxicity.
These patients may have an
increased heart rate as well.
They may be agitated or, in severe
cases, they may be in a coma.
They often appear pale or diaphoretic
and they may have vomiting.
They may be frankly acidotic
or they may be hypoglycemic.
So they can have a variety of
presentations along the spectrum.
Aspirin is sometimes in other preparations
and you should be aware
of that especially in
young children who’ve
overdosed on something.
So you can find aspirin in Pepto-Bismol,
which looks pink and delicious
to the young children.
You may find it in wart
and you may find it in
some herbal remedies.
So remember if you see a child
who got into the wart remover
and they have a fever, that this is
probably, ironically, aspirin overdose.
So how do we manage aspirin toxicity?
Well, there has to be some care with
the airway portion of the ABCs.
Remember, they may have a respiratory
alkalosis and a metabolic acidosis.
And so close monitoring of their
acid-base status is critical
in a patient who’s been intubated
with aspirin toxicity.
Likewise, you may want to correct
any hypokalemia or hypoglycemia.
And what’s key often in all overdoses
or at least many is GI decontamination.
If you can get to that patient within
an hour of when they overdosed,
you can administer charcoal and reduce
the amount of drug that’s absorbed.
Also, we may alkalinize the urine
in patients with aspirin toxicity
because that may be a more efficient way of
clearing the aspirin through the kidney.