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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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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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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 ...