pediatric toxicology

Question 1

supportive care

Answer 1

• airway stabilization
• early admin of antidote

Question 2

occurence

Answer 2

small rates of fatalities
agents: analgesics, cosmetics, household cleaners

Question 3

history questions

Answer 3

volume, # ingested, containers of sub, toxic subs in vicinity, other places child has been

Question 4

physical exam

Answer 4

mental status, vital signs, neurologic exam and pupil size/reactivity

Question 5

Labs

Answer 5

serum chemistries and acid base status
- alcohol ingestion: serum osmolality
- BB/CCB: ECG

Question 6

pediatric gastric decontamination

Answer 6

• discourage use of these strategies like syrup of ipecac and gastric lavage
  -activated charcoal .5- 1g/kg
• multiple dose activated charcoal 1g/kg (.5g/kg q4-6 hrs up to 24 hours)
• Whole Bowel Ingestion .5L- 1.2/2 L q4-6 hrs

Question 7

Foreign body ingestion s/s, offending agents, management

Answer 7

• toys, disc batteries, ornaments
• s/s: v/d, abdominal pain, fever, refusal to eat/drink, dysphagia
• management: observation for impaction, removal if occurs

Question 8

cough and cold preparations pearls, cause, management

Answer 8

• not recommended in children <6
• causes: multiple products w/ similar ingredients, inaccurate measurement, adult formulation, multi doses by multi caregivers
• management: activated charcoal and treat symptoms

Question 9

symptoms and treatment for cough and cold overdose

Answer 9

• HTN: Labetolol, Nicardipine
• Arrhythmias: Amidarone
• Seizures: Benzos

Question 10

Acetaminophen poisoning dose and treatment in children

Answer 10

• > 200mg/kg PO or >60mg/kg IV
• activated charcoal w/in 1 hr
• Antidote: NAC PO 18 doses over 72 hrs , IV 21 hrs

Question 11

Ethylene Glycol Poisoning MOA, AE, Treatment

Answer 11

• harmful metabolite
• ae: metabolic acidosis, cardiopulmonary compromise, dec mental status
• Pyridoxine + Thiamine
• Antidote: Ethanol + Fomepizole (prevents metabolism)

Question 12

Methanol Poisoning MOA, AE, Treatment

Answer 12

• harmful metabolite
• ae: metabolic acidosis, blindness
• folic acid
  antidote: ethanol or fomepizole

Question 13

Ethanol dose

Answer 13

• Load: 8ml/kg over 1 hr
• Inf 0.8ml/kg/hr

Question 14

when to use ethanol antidote

Answer 14

• serum conct of 100-150 mg/dl

Question 15

requirements/aes of ethanol

Answer 15

• central venous catheter
• CNS depresison
• respiratory depression
• TDM

Question 16

Fomepizole dosing

Answer 16

• Load: 15 mg/kg
• 10 mg/kg every 12 hours x 4
• 15 mg/kg every 12 hours until serum conct of toxic alcohol are <25 mg/dl

Question 17

Benefits of Fomepizole

Answer 17

• 1st line
• more cost effective
• less dosing errors
• less monitoring
• no need for central venous access
• no alt in level of consciousness

Question 18

Household cleaners

Answer 18

• 2nd most reported exposure in children
• management : support, GI injury PPIs