Related Experiment Videos
[Acute poisoning in childhood]
B Gossweiler1, P J Meier-Abt, P A Wyss
1Schweizerisches Toxikologisches Informationszentrum Zürich.
Insights
Accidental childhood ingestions are common, but severe outcomes are rare. Activated charcoal is effective for inhibiting absorption and enhancing clearance of many toxins, but not all.
Area of Science:
- Toxicology
- Pediatric Emergency Medicine
- Clinical Pharmacology
Context:
- Accidental ingestions are frequent in young children (1-3 years).
- Severe outcomes from childhood poisonings are uncommon.
- Accurate risk assessment is crucial to avoid unnecessary treatments.
Purpose:
- To review the efficacy of activated charcoal in managing childhood poisonings.
- To discuss alternative treatments like whole bowel irrigation.
- To emphasize prioritizing vital function support in severe cases.
Summary:
- Activated charcoal (1 g/kg) is effective for initial toxin absorption inhibition.
- Repeated doses (0.5 g/kg) enhance clearance of absorbed toxins.
- Whole bowel irrigation is an alternative for ineffective charcoal cases; gastric lavage and emesis are reserved for specific situations.
Impact:
- Guides appropriate therapeutic measures for accidental ingestions.
- Reduces unnecessary and potentially harmful interventions.
- Highlights the importance of evidence-based toxicology management in pediatrics.
Abstract:
Accidental ingestions of noxious substances are frequent events during childhood, especially in children one to three years of age. In contrast, severe symptoms and a serious outcome of these intoxications have been observed rather rarely; therefore, it is very important to avoid unnecessary and potentially harmful therapeutic measures. An extensive body of information has been collected nationally and internationally, allowing an accurate risk assessment in a constantly increasing number of cases. If there is need for treatment at all, the early application of activated charcoal (dose: 1 g/kg body weight) will efficiently inhibit absorption of noxious substances in most instances. Whereas the first dose of activated charcoal is administered to block absorption, repeated administration (0.5 g/kg body weight, every 2 to 4 hours) has been shown to shorten half-life and enhance the nonrenal clearance of chemically different substances even after absorption. Only few substances like heavy metals, lithium, or alcohols are not adsorbed by activated charcoal. Whole bowel irrigation may be a valuable alternative in cases where activated charcoal has been shown to be ineffective. Poisoning with ferrum formulations is an instructive example of this type of intoxication. Gastric lavage and pharmacologically induced emesis are no longer considered a routine treatment in poisoning but rather a special therapeutic option for very special situations. In all cases of severe poisoning, maintenance of vital functions, applying the principles of emergency medicine, has to have first priority.(ABSTRACT TRUNCATED AT 250 WORDS)