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When to think pediatric poisoning by aspirin, antihistamine, or alcohol.

Children's ingestion of aspirin, antihistamines, and alcohol often produce symptoms similar to other conditions.

Dr. Angela C. Anderson urged physicians to keep toxicology in mind when evaluating children.

"If you don't think about poisonings, you'll never be able to treat them," Dr. Anderson of Browan University, Providence, R.I., said during an interview. "Some toxins get better regardless of what you do, but other toxins can have a fatal outcome if you don't think about them as a possibility and treat them appropriately."

Aspirin poisoning may mimic a number of common pediatric illnesses, including pneumonia, meningitis, intracranial lesion, or psychiatric illness. Dr. Anderson reported on a decades-old study evaluating 73 consecutive aspirin poisonings. The researchers found 60% of the patients received a neurologic or psychiatric work-up, resulting in a 6-72 hour delay in diagnosis (Ann. Intern. Mud. 85[6]:745-48, 1976)

A toxic dose of salicylates is 150 mg/kg. For a 10-kg toddler, 3 ounces of extra strength Pepto Bismol is toxic, and 9 ounces is lethal. Salicylates stimulate the medulla, producing respiratory alkalosis; increase metabolism and lactic acid production; and promote bleeding.

"A patient presenting with fever, increased respiratory rate, and perhaps tales on exam, may in fact have pneumonia, but aspirin poisoning can present the same way," Dr. Anderson said.

Laboratory studies that suggest salicylate poisoning include the presence of a respiratory alkalosis with a concomitant anion gap metabolic acidosis. Management of salicylate poisoning includes preventing absorption by administering activated charcoal as well as urine alkalinization and whole bowel irrigation with GoLYTLEY. Hemodialysis also may be required in severe cases.

Antihistamines and anticholinergics are additional potentially dangerous categories of drugs found in homes and ingested by children; poisoning by these drugs that can easily be mistaken for something else when the child presents to the emergency department.

Dr. Anderson offered as a case example a terrified, agitated 4-year-old who kept rubbing her arms and legs, while scream ing "get them off of me." The child's temperature and heart rate were elevated, her skin flushed, her pupils dilated.

Children with acute anticholinergic poisoning often are anxious and agitated, have hallucinations, have seizures, or may lapse into a coma. The antidote physostigmine may be ordered but is contraindicated if the patient's electrocardiogram indicates a prolonged pace QRS. Patients also can be treated with benzodiazepines.

Dr. Anderson's take-home message: If the patient is "hot, dry, tachy, and wacky, think antihistamines."

Children also may ingest alcoholic beverages, and present with hypoactivity, hypothermia, hypoglycemia, and an altered mental state. The child may develop seizures. Treatment is symptomatic, such as administering glucose for hypoglycemia.

Ingestion of nitrates and nitrites can result in methemoglobinemia. Sources include lidocaine, benzocaine teething gels, aniline dye found in some shoe polishes, sulfonamides, Liquid Gold furniture polish, and other products. Think about methemoglobinemia when the baby appears lethargic and blue, the blood looks brown, and the partial pressure of oxygen (P[O.sub.2]) is normal.

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Title Annotation:Clinical Rounds
Author:Wood, Debra
Publication:Family Practice News
Geographic Code:1USA
Date:Oct 15, 2004
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