In this lecture, we will review
common poisonings in children.
It’s important to remember that
poisonings are more likely in
children with different agents.
So in children under five, typically,
poisonings will be unintentional
and they’ll be due to the child finding a
poison and then accidentally drinking it.
Or it can be from something such as
a dosing error in medication where
a parent misunderestimates the degree to
which they should be dosing their child
and then the child gets
too much medication.
Or it can be in the setting of child abuse.
Perhaps, the patient was forced
to take some horrible poison.
In adolescents, more commonly, poisonings
are a result of a suicide attempt.
Or they could be a result of
recreational substance abuse.
So let’s go through a little
bit what you want to check
for when you have a patient
who’s been poisoned.
It’s important to try and get a sense of
the timing and the amount of the drug.
In adolescents, this can be
They don’t always volunteer
which drugs they were taking
and they can often present with
polypharmaceutical drug overdose.
Also, it’s important to calculate the range
during which a patient
may have taken the drug.
Let me give you an example.
If a patient was left alone at 8 p.m.
in their room
and then the parent came in at 11 p.m.
and found them unconscious,
you can assume that some time between
8 and 11, they took the drug.
And you shouldn’t assume it was 11.
And the reason for that is
important because sometimes
our management and
treating these overdoses,
especially with Tylenol have to do with
knowing when the acute overdose occurred.
So this may not necessarily
be an accurate estimation
and also probably won’t be accurate
for child abuse situations.
It’s important to do vital signs
and do a thorough physical exam.
Assess the mental status and
also check pupillary size
because pupillary size
may give you some clues
as to what the agent was that’s
causing altered mental status.