Acute poisoning in children

The article was written by Doctor Le Van Binh - Pediatric Intensive Care Doctor - Vinmec Times City International General Hospital.

Children are always curious and explore their world with all their senses, including taste. As a result, the home and its surroundings can be a dangerous place for children to inadvertently ingest toxins. Every year, thousands of children are hospitalized because of poisoning. The forms of poisoning vary by age group, type of material exposed, and the nature and dose of the poison.

Acute poisoning (NDC) is when poison enters the body in a short time causing damage to organs and causing danger to the body. If not treated in time, it can cause death.
Every year, about 6 million children around the world suffer from food poisoning. In which, children under 5 years old account for 60-80%.
Poisoning tends to increase due to the arbitrary use of chemicals and drugs, the causative agents of NCDs are many, so it is difficult to identify. Children under 5 years old have a limited ability to fight and eliminate toxins, so when they are poisoned, they often need emergency care. When the disease is severe, it can easily cause death. However, today, with advances in diagnosis and resuscitation techniques, the mortality rate due to IBD is decreasing.

The diagnosis can easily be based on testimonies or items brought. However, there are many cases where it is very difficult, even with toxicology test results. Because the clinical manifestations of acute poisoning in children have many symptoms similar to other causes.
Definitive diagnosis is based on: medical inquiry, clinical examination and toxicology test.
2.1. Asking about the disease Asking the patient is a very important job because 90% of the cases can be based on testimonies and family items to determine the cause. Some questions can be asked such as:
What do children eat and drink? How much is the food intake? How long does it take to eat? What is the first symptom? Do other people eating and drinking with the same symptoms as children? What first aid measures did you take before going to the hospital?

2.2. Clinical examination 2.2.1. Assessment of vital functions Respiratory: Breathing rate (l/min), respiratory muscle contractions, cyanosis, measuring SpO2 Cardiovascular: brachial pulse, heart rate, blood pressure, Refill. Neurological: Consciousness (AVPU scale) abnormal posture, muscle tone, paralysis. Pupils: Constriction, dilation, pupillary reflex. Body temperature: Fever or hypothermia. 2.2.2. Find the guiding symptom

2.3. Diagnostic tests Toxicology: Blood, urine, gastric juice. Blood tests: CTM, GA, glucose, calcium, urea, creatinine, blood gases, coagulation,... Electrocardiogram, pulse monitoring, blood pressure, sp02. X-ray Pulmonary EEG. 2.4. Rate the level

2.5. Diagnosis of toxic syndrome

2.6. How to diagnose acute poisoning Easy diagnosis: Based on testimonies and exhibits.
Difficult diagnosis: Must be based on two of the following three criteria:
Ask the patient carefully to find evidence: Using drugs, chemicals. Symptoms come on suddenly: The child was previously healthy. Toxicology testing consistent with clinical symptoms.

Mainly due to the unconsciousness of adults in the preservation of drugs and chemicals in food for children to eat or drink: Because the family self-administers the drug without a prescription from a doctor or medical officer and uses it improperly. Age of acute poisoning: Any age, from birth to 15 years old. Common: 1 - 3 years old, boys see more than girls due to hyperactivity. Children under 5 years old account for 70%. Drug poisoning: Mainly children < 1 year old. Food and chemical poisoning: Mainly children > 6 years old. The cause of acute poisoning in young children is often easy to detect because it is not hidden, older children can be poisoned by trying to commit suicide because of conflicts with family, friends, teachers,... Need to be careful when taking medical history of children. Common poisoning routes: Gastrointestinal tract (70%), respiratory tract (5%), skin (7%),... Clinical features of acute poisoning in children are different from adults due to biological characteristics of the nervous system. The central part is not yet perfect and vulnerable. The liver and kidney are the two main detoxification organs, but their function is immature, so they are prone to drug accumulation. Therefore, small doses in children can cause acute poisoning; or there are drugs that inhibit adults but children cause irritation such as pipolphen, ...

4.1. Principles Urgency and coordination of key measures:
Maintain vital functions. Eliminate toxins from the body. Toxic neutralization. Specific detoxification. Homeostasis, symptoms and nutritional care. 4.2. Treatment measures 4.2.1. Emergency treatment Eliminate danger Maintain vital function, manage according to A.B.C. sequence. 4.2.2. Induce vomiting Advantages: Simple, easy to use, effective for poisoning < 6 hours. Indications: Children awake, poisoning < 6 hours. Contraindications: Poisoning with hydrocarbons (petroleum), strong corrosive substances (acids, bases), coma, convulsions in children. Method : Fingers, cotton swabs to stimulate throat.
Drink Ipeca 7 - 10% solution:
Children < 1 year old: 10 ml.
Children 1 - 10 years old: 15 ml.
Children > 10 years old: 30 ml.
After 15-20 minutes, most children vomit, remove 30-40% of the substance when eating < 1 hour.
Can be repeated after 20 minutes.
Apomorphine 0.01g/1ml dermal injection, dose from 1/3 to 1/2 ampoule depending on age, not for children < 5 years old.
4.2.3. Gastric lavage Simple and effective method. Indications: Poisoning < 6 hours, patients awake, comatose must be intubated first. Method: Warm water mixed with 5g salt/1 liter, 0.9% saline serum, 0.5% potassium permanganate solution, or 10g activated charcoal/1 liter. Or put a nasogastric tube to pump 10-20ml/kg/wash until the liquid is clear and the odor is gone. Contraindications: Poisoning with corrosive substances.

4.2.4. Laxative Indications: After gastric lavage or poisoning > 6 hours. Method: Paraffin oil, Magnesium sulfate (4 - 8 ml/kg), Sorbitol 2 ml/kg.
Be careful with children < 2 years old because of possible dehydration - electrolytes.
4.2.5. Diuresis more Indications: Poisoning but toxic waste through the kidney, good kidney function in young children. Method: Drink lots of water.
Glucose solution 10% + electrolyte solution: 120-150 ml/kg or 2-3 liters/m2 skin/24 hours.
Mannitol 1g/kg, Lasix 1 - 2 mg/kg
Causing alkalization or acidification of the urine:
Alkalizing: Bicarbonate 14%o, Protopam.
Acidification: Vitamin C, Ammonium Chloride.
4.2.6. Dialysis Modern, effective method, reducing mortality. Helps regulate water - electrolytes, acid-base. Indications: Poisoning with heavy metals, poisonous mushrooms. 4.2.7. Blood exchange Indications for patients with hemolytic poisoning, hepatocellular toxicity: Mushrooms, salicylic acid.
4.3. Detoxification 4.3.1. Non-specific Method of absorption: Use activated charcoal after gastric lavage, pump 10g mixed with 50ml water or 1g/kg every 8 hours. Some poisons: Give milk to drink. Chemical neutralization: Alkali poisoning using lemon and vinegar. Acid poisoning using alkaline. Heavy metal poisoning: Using egg whites,... 4.3.2. Specific detoxification

4.4. Treatment of functional disorders is a non-specific method, but it is important because it determines the patient's life. Including measures:
Rehydration - electrolytes, rehydration, correction of electrolyte disorders, anti-acidosis based on clinical, blood gas. Anti-respiratory failure: Absorb sputum widely, posture, breathe O2, support respiration. Anti-shock, vasoconstriction: IV fluid replacement, when blood pressure is low, use vasopressor Dopamine. Antipyretic, sedative, anticonvulsant. Please follow the website: Vinmec.com regularly to update many other useful information.