Pediatric ingestions present a common challenge for emergency clinicians. While findings and information from the physical examination, electrocardiographic, laboratory, and radiologic testing may suggest a specific ingestion, timely identification of many substances is not always possible. In addition to diagnostic challenges, the management of many ingested substances is controversial and recommendations are evolving.
Our recent issue Management of Pediatric Toxic Ingestions in the Emergency Department reviews the initial resuscitation, diagnosis, and treatment of common pediatric ingestions. Also discussed are current recommendations for decontamination and administration of antidotes for specific toxins.
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Here are a few key points:
- The most common pediatric ingestions reported to the National Poison Data System include cosmetics/personal care products (10.8%), household cleaning substances (10.7%), analgesics (8%), dietary supplements/herbal supplements/homeopathic products (7%), and foreign bodies/toys/miscellaneous (6.5%). (See Table 1 in the issue.)
- Patients may present with mixed or atypical toxidromes. Consider polysubstance ingestion or recreational synthetic drugs in these cases.
- When an ingested substance is unknown, appropriate diagnosis and management begins with an assessment of any abnormal vital signs and a focused history and physical examination to identify signs and symptoms of common toxidromes, as presented in See Table 3 in the issue.
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