368 Paediatric Emergencies
ACUTE POISONING3 Give naloxone 10–40 g/kg i.v., or i.m. if venous access is impossible, when
there are pinpoint pupils and respiratory depression.
4 Start an i.v. infusion of normal saline and give 10–20 mL/kg for hypotension.
5 Give activated charcoa l 1–2 g/kg to reduce the absorption of toxin.
(i) Charcoal is unpalatable and difficult to administer in children,
but may be given mixed with ice cream or via an NGT
(a) be aware that administration of activated charcoal via a
misplaced NGT in the bronchial tree has resulted in death.
(ii) It is of most benefit within 1–2 h of ingestion, and is not effective
against certain substances (see p. 168).
(iii) Charcoal decontamination is reserved for severe or life-
threatening poisoning, where a risk assessment suggests that
supportive care or antidote treatment alone does not ensure a
safe outcome.
6 Ipecacuanha should no longer be used in acute poisonings and gastric lavage
is now rare, unless the child presents within 1 h of ingesting a highly lethal
drug, and/or is unconscious with the airway protected by an endotracheal
tube.
7 Tablets that are particularly toxic even if just two tablets are ingested in a
toddler (10 kg) are listed in Table 11.6.Table 11.6 Highly toxic tablets, even if just two tablets are ingested by a 10 kg
toddlerAgent Features of severe toxicity
Amphetamines Agitation, confusion, hypertension,
hyperthermia
Calcium-channel blockers Delayed onset of bradycardia,
hypotension, cardiac conduction
defects, refractory shock
Chloroquine/hydroxychloroquine Rapid onset of coma, seizures and
cardiovascular collapse
Dextropropoxyphene Ventricular tachycardia
Opioids Coma, respiratory arrest
Propranolol Coma, seizures, ventricular
tachycardia, hypoglycaemia
Sulfonylureas Hypoglycaemia
Theophylline Seizures, supraventricular
tachycardia, vomiting
Tricyclic antidepressants Coma, seizures, hypotension,
ventricular tachycardia