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]

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

  1. Benzocaine
  2. Beta Blocker Overdose
  3. Calcium Channel Blocker Overdose
  4. Chloroquine
  5. Clonidine Overdose
  6. Iron preparations
    1. One of the most toxic agents in Overdose for small children
    2. Morris (2000) South Med J 93(4): 352-8 [PubMed]
  7. Lindane
  8. Methyl Salicylate (oil of wintergreen - even in small amounts)
  9. Opioid Overdose
    1. Lomotil
    2. Methadone
    3. Oxycodone
  10. Oxymetolazoline (Afrin) - see below
  11. Phenothiazines
  12. Phenylpropanolamine
  13. Podophyllum
  14. Quinine
  15. Quinidine
  16. Sulfonylurea Overdose
  17. Tea Tree Oil
  18. Theophylline
  19. Tricyclic Antidepressant Overdose
  20. Bar-Oz (2004) Paediatr Drugs 6(2): 123-6 [PubMed]

IV. Causes: Medications with Higher Toxicity

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

  1. Alcohols (Ethanol, Methanol, Ethylene Glycol)
  2. Benzocaine
  3. Caustics (e.g. toilet cleaners, drain cleaners)
  4. Hydrocarbons (Kerosene, furniture polish, paint thinner, lighter fluid)
  5. 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
  6. Lindane
  7. Methyl Salicylate (oil of wintergreen)
  8. Nail products (acetonitrile, methacrylic acid, nitromethane)
  9. Organophosphates
  10. 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
  11. Paraquat Poisoning
  12. Podophyllum
  13. Tea Tree Oil

VI. Causes: Toxins with delayed effects in Overdose

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