MANAGEMENT OF THE INTOXICATED PATIENT
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.
In particular, poison control centers, if available, provide immediate and expert advice from trained specialists in poison information to aid the practitioner in the management of poisoned patients, with particular reference to decontamination, antidotes, or other medical treatment; selection of appropriate laboratory tests; and enhanced drug elimination.
The goal of poison prevention programs is to prevent pediatric poisoning through legislation and educational strategies; medication safety, such as parental anticipatory guidance regarding medication; and household safety during well-child visits. Brochures and other poison prevention materials can be obtained from local poison centers or through national bodies and legislative initiatives, such as the Poison Prevention Packaging Act (in the United States) have been instrumental in decreasing the impact of childhood poisoning.
Young children usually have little difficulty finding toxic substances, which can result in accidental poisoning. Personal-care products and cleaning substances are the most common agents involved in household intoxications, although pharmaceutical products are responsible for the majority of fatalities. Analgesics are the most common pharmaceutical exposure.
There are fewer adolescent exposures reported to poison centers compared with younger children, but most adolescent poisonings are intentional and involve greater amounts of toxins, often with multiple agents, and with delayed presentation for medical attention. As a consequence, adolescent poisonings often result in more serious toxicity.
Evaluation of the Poisoned Patient
A presumptive diagnosis can often be made using information from the history, vital signs, and physical examination before extensive laboratory results are available. The type of toxin, timing, amount, and route of exposure are ascertained by asking the patient, family members, or other sources, and are critical to guiding therapy. The circumstances of the exposure and history of psychiatric illness help determine the risk for intentional harm. Potentially toxic household products such as automotive and cleaning products should not be overlooked. Paramedics and first responders provide important information about the scene of exposure and progression of the patient’s signs and symptoms.
Discussion with the Poison Center
The value of a discussion with the local poison center cannot be overstated in terms of identification of substances through diagnostic tests, but also in piecing together the puzzle of unusual toxidromes and, equally importantly, in guiding immediate and longer term investigations and therapeutic interventions.
Toxidromes or “toxic syndromes,” are characteristic physical findings that indicate the presence ...