Special considerations in the poisoned pediatric patient

The incidence of serious pediatric morbidity and mortality has fortunately declined over the past two decades due to better prevention efforts, the development of regionalized poison information programs, and advances in the emergency management and critical care of poisoned patients. Still, children continue to explore and often ingest many substances they discover in their world. Some of these children will become patients who present to the emergency department, requiring a coordinated approach to the seriously or even critically ill poisoned child by physicians who can access specialized resources to manage a vast spectrum of potential toxins. This article summarized one such approach, emphasizing initial attention to life support priorities, followed by a detailed evaluation process using readily available clinical and laboratory data. Management strategies including decontamination, urgent antidotal therapy, initiation of excretion enhancement, and optimal supportive care were reviewed. Several specific intoxications were illustrated briefly in an attempt to facilitate pattern recognition of characteristic pediatric exposures.