Emergency Medicine

Paediatric Emergencies 367

Acute Poisoning

Most cases of acute poisoning in children are accidental, although rarely deliber-
ate poisoning may occur as a form of child abuse, and adolescents may attempt
suicide.

Obtain advice as necessary regarding toxic ingestions 24 h a day from the Poisons
Information Centre on 13 11 26 (Australia), and in New Zealand on 03 479 7248
(or 0800 764 766 within New Zealand only).

Advice in the UK is available from the National Poisons Information Service
(NPIS), comprising four individual units (Birmingham, Cardiff, Edinburgh,
Newcastle). The NPIS coordinates an Internet and telephone service to assist in
the diagnosis, treatment and management of all types of poisonings.

● TOXBASE

®

is an online resource for the routine diagnosis, treatment and

management of patients exposed to toxic substances. Use this as the first point

of contact for poisons advice. It is available on http://www.toxbase.org/

● Specialist consultants are available for telephone advice in more complex

clinical cases. A 24-h number 0844 892 0111 will direct callers to the relevant

local centre in the UK.

DIAGNOSIS

1 Four categories of substances may be ta ken:

(i) Proprietary tablets and syrups, often prescribed for the parents.

(ii) Household and garden chemicals.

(iii) Leaves, berries, seeds and fungi.

(iv) Alcohol, solvents and other illicit substances.

2 It is important to ascertain what was taken, how much and when. If possible,

the container the poison was in, or an example of the f lora ingested, should

be brought with the child.

3 Record baseline observations of temperature, pulse, blood pressure,

respiratory rate, level of consciousness, and a blood glucose test stick for

hypoglycaemia, particularly in alcohol and salicylate poisoning.

4 Send blood for U&Es, blood sugar and a drug screen, which may include a

paracetamol, iron, salicylate, theophylline or alcohol level as indicated

clinically.

MANAGEMENT

1 Clear the airway and give oxygen. Use a bag and mask if the gag ref lex is

absent, with an oropharyngeal airway, and call an airway-skilled doctor

urgent ly to intubate t he child.

2 Give 10% dextrose 5 mL/kg i.v. if the blood sugar level is low.