Activated Charcoal

Category: generalpediatrics-Emergency Medicine

Findings: acetaminophen, anticholinergics, aspirin, TCAs, theophylline

Notes: Give if ingestion was under an hour ago. Dosage 1 g per kg. Charcoal is not useful for ingestion of metals, acids, bases, organophosphates, cyanide, alcohols, lithium.

Question: What substance can be used to treat the following ingestions?

Alcohol

Category: generalpediatrics-Emergency Medicine

Findings: hypoglycemia, ataxia, positive anion gap, vomiting, hypokalemia, confusion, clammy skin

Notes: Treat hypoglycemia and hypokalemia.

Question: What substance over-ingestion causes these findings?

Botulism

Category: generalpediatrics-Emergency Medicine

Findings: constipation, ptosis, head lag, hypotonia in infant

Notes: Descending paralysis due to ingestion of spores from Clostridium botulinum found in soil and honey. Treat with human botulism immune globulin IV infusion.

Carbon Monoxide Poisoning

Category: generalpediatrics-Emergency Medicine

Findings: flushed red skin, ataxia, confusion, vomiting, upset stomach, headache, flu-like symptoms, space heater

Notes: Treat with one hundred percent oxygen, in hyperbaric chamber if severe. Check carboxyhemoglobin levels on CO oximeter as SpO2 and PaO2 on ABG are usually normal.

Question: Which disease is associated with these findings?

Child Abuse

Category: generalpediatrics-Emergency Medicine

Findings: torso, ear, neck

Notes: Bruising over torso, ear, and neck in a child under 4 years old is concerning for child abuse. Also look for retinal hemorrhages, fractures across long bones, rib, and fractures in multiple states of healing, and strange burns.

Question: Bruising over the following body parts is concerning for what?

Compartment Syndrome

Category: generalpediatrics-Emergency Medicine

Findings: displaced tibial or supracondylar fracture, pain out of proportion to fracture, pain remote to fracture

Notes: Obtain emergent orthopedic consult

Question: What may occur with these findings?

Ethylene Glycol

Category: generalpediatrics-Emergency Medicine

Findings: calcium oxalate crystals, positive anion gap acidosis, hypocalcemia

Notes: Treat with fomepizole, ethanol, or emergent hemodialysis

Question: What substance ingestion causes these findings?

Gastric Lavage

Category: generalpediatrics-Emergency Medicine

Findings: acid, base, and hydrocarbon ingestions

Question: What poison treatment method is contraindicated with the following substances?

Increased Intracranial Hypertension

Category: generalpediatrics-Emergency Medicine

Findings: hypertension, bradycardia, irregular breathing

Notes: Also called Cushings triad.

Question: Which disease is associated with these findings?

Iron

Category: generalpediatrics-Emergency Medicine

Findings: hypotension, capillary leak, abdominal pain, narrowing of pylorus, cardiomyopathy, anion gap acidosis, undigested pills in abdomen

Notes: Treat with chelation such as with deferoxamine

Question: What substance over-ingestion causes these findings?

Isopropyl Alcohol

Category: generalpediatrics-Emergency Medicine

Findings: dizziness, headache, ethanol reading on toxicology report, fruity breath, no anion gap

Question: What substance ingestion causes these findings?

Marijuana

Category: generalpediatrics-Emergency Medicine

Findings: gynecomastia, inattention, mydriasis

Notes: Most common illicit drug.

Question: What substance use causes these findings?

Methanol

Category: generalpediatrics-Emergency Medicine

Findings: blurry vision, photophobia, anion gap acidosis, abdominal pain, car washer fluid

Notes: Causes visual anomalies in addition to anion gap acidosis. This is different from ethylene glycol, which causes renal problems.

Question: What substance ingestion causes these findings?

Miosis

Category: generalpediatrics-Emergency Medicine

Findings: clonidine, cholinergics, opiates, organophosphates, pilocarpine, barbiturates

Notes: 2 mm or less pupil size

Question: What pupil effect do these drugs cause?

Mydriasis

Category: generalpediatrics-Emergency Medicine

Findings: antihistamines, antidepressants, anticholinergics, amphetamines, cocaine

Notes: 5 mm or greater pupil size.

Question: What pupil effect do these drugs cause?

Octreotide

Category: generalpediatrics-Emergency Medicine

Findings: next therapy to use in lethargic child with hypoglycemia after unknown ingestion after glucagon and dextrose IV fluids has not resolved the hypoglycemia

Notes: Octreotide is a long-acting somatostatin analog that inhibits insulin secretion that may be promoted by sulfonylureas.

Phencyclidine (PCP)

Category: generalpediatrics-Emergency Medicine

Findings: nystagmus, ataxia, muscle rigidity, rhabdomyolysis, paranoia, agitation, hypertension, hallucinations, violence, lid edema

Notes: May treat with haloperidol and cooling blanket.

Salicylates

Category: generalpediatrics-Emergency Medicine

Findings: tachypnea, primary respiratory alkalosis, cerebral edema, pulmonary edema

Notes: Treat with charcoal, gastric lavage, fluids, bicarbonate to alkinalize urine, hemodialysis

Question: What substance over-ingestion causes these findings?

Tricyclic Antidepressant (TCA)

Category: generalpediatrics-Emergency Medicine

Findings: anion gap acidosis, tachycardia, coma, seizures, wide QRS, QT prolongation, ventricular fibrillation

Notes: Treat with sodium bicarbonate, or give charcoal or perform gastric lavage if patient presents within an hour

Question: What substance over-ingestion causes these findings?