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Morbidity and mortality from childhood poisoning have decreased in the last few decades. This decrease can be credited to the development of poison control centers with a sophisticated poison management database, new governmental regulations, widespread use of child-resistant enclosures for medications, safer packaging for consumer products, public education and anticipatory guidance, and a growing understanding of the environmental and pharmacologic foundations of toxicology.

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In particular, poison control centers provide immediate and expert advice from trained specialists in poison information to aid the practitioner in the management of poisoned patients. In the United States, 1-800-222-1222 is the nationwide toll-free number connecting any caller to an American Association of Poison Control Center regional poison center. A clinical toxicologist is available on request to provide consultation regarding decontamination, antidotes or other medical treatment, selection of appropriate laboratory tests, and enhanced drug elimination.

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Poison Prevention

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The goal of poison prevention programs is to prevent pediatric poisoning through legislation and educational strategies such as parental anticipatory guidance during well-child visits (Table 120-1). Brochures and other poison prevention materials can be obtained from local poison centers or the American Academy of Pediatrics. Legislative initiatives such as the Poison Prevention Packaging Act have been instrumental in decreasing the impact of childhood poisoning.

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Table 120-1. Poison Prevention Strategies
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Epidemiology

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Young children usually have little difficulty finding toxic substances. Personal-care products and cleaning substances are the most common agents involved in household intoxications, though pharmaceutical products are responsible for the majority of fatalities. Analgesics are the most common pharmaceutical exposure.

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There are fewer adolescent exposures reported to poison centers compared with younger children. Most adolescent poisonings are intentional, and involve greater amounts of toxin, as well as exposure to multiple agents. Exposures in the younger child are usually unintentional. Delayed presentation for medical attention can also complicate medical care. As a consequence, adolescent poisonings often result in more serious toxicity.

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Evaluation of the Poisoned Patient

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Determining the type of toxin involved guides therapy. The presumptive diagnosis can often be made using information from the history, vital signs, and physical examination before extensive laboratory results are available.

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The type of toxin, timing, amount, and route of exposure are ascertained ...

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