Emergency Medicine Book

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Accidental Poisoning Causes

Aka: Accidental Poisoning Causes, Poisoning Causes, Poisoning Causes in Children, Medication Overdose Causes, One Pill Can Kill, KIDs List, Key Potentially Inappropriate Drugs in Pediatrics
  1. See Also
    1. Poisoning
  2. 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]
  3. Causes: Lethal agents to small children (<10 kg) in small doses ("One Pill Can Kill")
    1. Benzocaine
    2. Benzonatate Overdose (Tessalon)
    3. Beta Blocker Overdose
    4. Calcium Channel Blocker Overdose
    5. Chloroquine
    6. Clonidine Overdose
    7. 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]
    8. Lindane
    9. Methyl Salicylate (oil of wintergreen - even in small amounts)
    10. Opioid Overdose
      1. Lomotil
      2. Methadone
      3. Oxycodone
    11. Oxymetolazoline (Afrin) - see below
    12. Phenothiazines
    13. Phenylpropanolamine
    14. Podophyllum
    15. Quinine
    16. Quinidine
    17. Sulfonylurea Overdose
    18. Tea Tree Oil
    19. Theophylline
    20. Tricyclic Antidepressant Overdose
    21. Bar-Oz (2004) Paediatr Drugs 6(2): 123-6 [PubMed]
  4. 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]
  5. Causes: Medications with Higher Toxicity
    1. Beta Blocker Overdose
    2. Calcium Channel Blocker Overdose
    3. Chloroquine
    4. Clonidine
    5. Glucophage
    6. Iron preparations
    7. Isoniazid
    8. Lomotil
    9. Methadone
    10. Oxycodone
    11. Phenothiazines
    12. Phenylpropanolamine
    13. Quinine
    14. Quinidine
    15. Sulfonylureas
    16. Theophylline
    17. Tricyclic Antidepressant Overdose
  6. 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
  7. Causes: Toxins with delayed effects in Overdose
    1. Acetaminophen Overdose
    2. Acetonitrile
    3. Anticoagulants (e.g. Warfarin)
    4. Aspirin or Salicylate Overdose
    5. Carbamazepine (Tegretol)
    6. Dapsone
    7. Enteric-coated or sustained release medications
    8. Ethylene Glycol (also in laundry pods)
    9. Iron
    10. Lithium
    11. Lomotil
    12. Meprobamate
    13. Methanol
    14. Monoamine Oxidase Inhibitors
    15. Sulfonylureas
    16. Theophylline
    17. Thyroid hormones
    18. Toxic Mushrooms
    19. Barry (2005) Pediatr Ann 34(12):937-46 [PubMed]

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