II. Epidemiology: Incidence of specific agents in childhood Poisonings

  1. Most common: Cosmetics, personal care products, cleaning agents
  2. Moderately common: Analgesics, topicals, Cold Preparations
  3. Other: Plants, Pesticides, Vitamins, Antihistamines, antibiotics, arts and craft supplies
  4. Most common cause of pediatric lethal Overdose (even single doses may be lethal to a toddler)
    1. Sedative-Hypnotics (esp. Benzodiazepine Overdose)
    2. Antipsychotics
    3. Oral Hypoglycemic agents (esp. Sulfonylurea Overdose such as Glipizide 5 mg)
    4. Cardiovascular agents (e.g. Calcium Channel Blockers such as Verapamil 240 mg)
    5. Analgesics (e.g. Acetaminophen Overdose, Opioids such as Methadone 20 mg)
  5. References
    1. (2014) Presc Lett 21(3)
    2. Watson (2005) Am J Emerg Med 23(5): 589-666 [PubMed]

IV. Causes: Lethal agents to small children (<10 kg) in small doses ("One Pill Can Kill")

V. Causes: Key Potentially Inappropriate Drugs in Pediatrics (KIDs List)

  1. Background
    1. Examples are listed below
    2. Remainder of this page overlaps many of the drugs on KIDs List
  2. Antiemetics
    1. Dopamine blockers (Prochlorperazine, Promethazine)
      1. Risk of respiratory depression and Dyskinesia
      2. Avoid under age 2 years, and Exercise caution in children over age 2 years
    2. Alternative agents that are preferred
      1. Ondansetron (Zofran)
  3. Analgesics
    1. Codeine and Tramadol
      1. Avoid in all children
      2. Some children are CYP2D6 ultra-metabolizers
      3. Risk of erratic blood levels that spike and result in respiratory depression and death
    2. Oxycodone and Hydrocodone
      1. Exercise caution as these agents are also metabolized by CYP2D6
      2. Has not been associated with pediatric toxicity as seen with Codeine and Tramadol
    3. Alternative agents that are preferred
      1. Acetaminophen
      2. Ibuprofen
      3. If Opioid is needed, consider short-acting oral Morphine
  4. Topical Anesthetics
    1. Benzocaine
      1. Avoid in all children (previously used for Teething)
      2. Risk of Methemoglobinemia
    2. Alternative agents that are preferred
      1. See Teething
  5. Gastrointestinal Agents
    1. Loperamide (Imodium)
      1. Avoid in all children (despite FDA approval over age 6 years)
      2. Risk of ileus, Somnolence, death (especially age <3 years)
    2. Alternative agents
      1. See Diarrhea Management in Children
  6. Topical Corticosteroids
    1. Limit to low potency steroids if possible (due to systemic absorption risk)
  7. References
    1. (2020) Presc Lett 27(8): 45
    2. Meyers (2020) J Pediatr Pharmacol Ther 25(3): 175-91 +PMID:32265601 [PubMed]

VII. Causes: Non-Medications or Topical Agents with Higher Toxicity

  1. Alcohols (Ethanol, Methanol, Ethylene Glycol)
    1. Hand sanitizer contains >60% Alcohol
    2. Even a small amount can result in Alcohol Poisoning in a young child
  2. Benzocaine
  3. Bleach (sodium Hypochlorite)
    1. Commercial concentrations that exceed that found in household bleech (3-6%) have greater toxicity
    2. Esophageal inflammation or pulmonary aspiration if ingested; Inhalation Injury in higher concentrations
    3. Highly toxic when Bleach is combined with ammonia
      1. Results in chloramine gas release, which has resulted in fatalities
  4. Caustics (e.g. toilet cleaners, drain cleaners)
  5. Hydrocarbons (Kerosene, furniture polish, paint thinner, lighter fluid)
  6. Laundry Pods (contain Ethylene Glycol and ethoxylated Alcohols)
    1. Have resulted in deaths and life threatening Poisonings
    2. Esophageal Thermal Burns may occur
    3. Observe for 3-4 hours while trialing oral liquids
    4. Swadron and Nordt in Herbert (2016) EM:Rap 16(11): 16-7
  7. Lindane
  8. Methyl Salicylate (oil of wintergreen)
  9. Nail products (acetonitrile, methacrylic acid, nitromethane)
  10. Organophosphates
  11. Oxymetolazoline (Afrin)
    1. Even 1 ml may be lethal due to central alpha-2 Agonist, Clonidine-like CNS depression)
    2. If a nasal Decongestant is used in children, Neo-Synephrine (Phenylephrine) is preferred
  12. Paraquat Poisoning
  13. Podophyllum
  14. Tea Tree Oil

VIII. Causes: Toxins with Delayed Effects in Overdose

IX. Prevention

X. References

  1. Tagliaferro (2023) Crit Dec Emerg Med 37(1): 21-9

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