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[Acute toxic exposure in children: an overview]
Fábio Bucaretchi1, Emílio C E Baracat
1Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP. bucaret@fcm.unicamp.br
Jornal De Pediatria
|December 16, 2005
Summary
Routine gastrointestinal decontamination and multiple-dose activated charcoal are not supported by evidence for acute toxic exposures in children. Specific antidotes like fomepizole and octreotide show promise for certain poisonings.
Area of Science:
- Pediatric Toxicology
- Emergency Medicine
- Clinical Pharmacology
Context:
- Acute toxic exposures are common in young children, though fatalities are rare.
- Current practices in gastrointestinal decontamination lack robust evidence for improving outcomes.
- Limited availability and high cost of specific antidotes pose challenges in certain regions like Brazil.
Purpose:
- To review the scientific literature on acute toxic exposures in children, excluding envenomations.
- To evaluate the efficacy of gastrointestinal decontamination methods and specific antidotes.
- To provide evidence-based recommendations for managing pediatric poisoning.
Summary:
- Gastrointestinal decontamination (ipecac, cathartics) and multiple-dose activated charcoal lack evidence of benefit in improving outcomes for poisoned children.
- Single-dose activated charcoal and gastric lavage may be considered within one hour of ingestion for potentially toxic or lethal ingestions, respectively.
- Specific antidotes like fomepizole (for alcohol poisoning) and octreotide (for sulfonylurea poisoning) are effective and safe.
Impact:
- Challenges routine use of ipecac syrup and cathartics in outpatient settings.
- Highlights the limited role of broad gastrointestinal decontamination in pediatric poisoning management.
- Emphasizes the importance of targeted antidotes for specific toxic ingestions.