Poisoning can take place when a poisoning agent enters the body through one of the following routes: ingestion, inhalation, absorption through the skin/eyes, or through bites. Poisoning should be suspected in any unexplained illness in a previously healthy child. The child should be assessed for emergency and priority signs listed in this manual and managed accordingly. History of exposure to a poisoning agent should be enquired about from the mother/care taker. The container of the poisoning agent may give a clue to its nature. When the poisoning agent is identified management should be planned accordingly. Following are the common poisons and main lines of management.

General measures

A. Ingested poisons

Gastric decontamination/lavage by inducing vomiting:

  • NO: When the child is unconscious and with the ingestion of corrosives or petroleum products.
  • YES: If the patient is conscious and within one hour of ingestion.

How?

  • If activated charcoal is available, give by mouth or NG tube, and do not induce vomiting.
    • 1 year or over, give 25-50 gm
    • Less than 1 year, give 1gm/kg
  • If charcoal is not available, induce vomiting by rubbing the back of the throat with a spatula or by giving emetics.
    Never use salt as an emetic. Give water or milk.
  • Perform gastric lavage only when experienced staff is available.
  • Give ipecacuanha to induce vomiting.
  • Keep under observation (4–24 hours) and give general supportive care.

Pediatric ipecacuanha Dosage:

6–24 months: 10ml

> 24 months: 15 ml

B. Inhaled poisons

  • Remove from source.
  • Administer supplemental oxygen if needed.
  • Observe and refer if needed.

C. Skin Contamination

  • Remove all clothing, and store safely in a plastic bag.
  • Wash body/area thoroughly with water, use soap for oily substances.
  • Protect staff from secondary contamination by protective clothing and gloves.

D. Eye Contamination

  • Protect other eye while rinsing.
  • Rinse eye for 10–15 minutes with clean running water or saline.
  • Refer for further evaluation by ophthalmologist.

E. Specific poisons

  • Organo-phosphorous and carbamate compounds:
    These can be ingested, inhaled or absorbed through the skin. May cause vomiting, diarrhea, blurred vision, weakness, salivation, sweating, lacrimation, or serious circulatory, respiratory and neurological symtoms and signs.
    Do not induce vomiting.
    • Wash skin and eyes (as above).
    • Give activated charcoal if within one hour (if not available consider careful aspiration of the stomach with NG tube.
    • If excess symptoms (blurred vision, salivation etc) give atropine IM (0.015-0.05 mg/kg).
    • Monitor respiratory secretions, respiratory rate and heart rate.
    • Repeat atropine every 15 minutes until chest is clear and respiratory rate and heart rate are normal.
  • Paracetamol
    • If within one hour, give active charcoal or induce vomiting.
    • Refer for antidote and further management if possible.
  • Aspirin and other Salicylates
    • Give activated charcoal if available, if not perform gastric lavage and induce vomiting,
    • Refer for further management.
  • Iron
    If asymptomatic during the first 6 hours, no need for antidote.
    If symptomatic:
    • Perform gastric lavage.
    • If serious, refer.
  • Carbon monoxide poisoning
    • Give 100% oxygen.
    • Monitor for hypoxaemia.

F. Envenoming

  • Snake
    Avoid cutting wound and applying tourniquet
    • Splint and elevate limb, apply firm bandage, clean wound, give analgesic, give antitetanus prophylaxis.
    • Refer for antivenom, if possible.
  • Scorpion
    • Give analgesics.
    • Refer, if possible.