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Poisoning in children
Most poisoning in toddlers is accidental ingestion of medicines and household products; the approach is ABC, estimating the dose per kilogram, recognising a toxidrome and contacting a poison information centre — and a small group of drugs can kill a toddler with a single pill.
Why it matters in the exam
Questions revolve around a few "classic" poisonings. Paracetamol: a dose above 150 mg/kg needs a serum level drawn 4 hours post-ingestion, plotted on the nomogram; when the level lies over the treatment line — acetylcysteine (NAC), most effective when started within 8 hours. Iron: more than 60 mg/kg of elemental iron is dangerous; stages of vomiting and bloody diarrhoea, a "misleading calm", then shock, acidosis and liver injury; the tablets are seen on an abdominal X-ray, and deferoxamine is given in severe poisoning.
A second point is what not to do: do not induce vomiting; activated charcoal (1 g/kg, up to 50 g) is considered only within one hour of ingestion and only when the airway is protected, and it does not bind iron, lithium, alcohols, hydrocarbons, acids or alkalis. After a caustic ingestion do not neutralise and do not give charcoal; the absence of oral burns does not exclude oesophageal injury, and a child with drooling, stridor or vomiting needs endoscopy. With hydrocarbon (kerosene) ingestion the danger is aspiration and chemical pneumonitis.
Also remember the "one pill can kill" group: tricyclic antidepressants (wide QRS → sodium bicarbonate), calcium channel and beta blockers, sulfonylureas (delayed hypoglycaemia — 24-hour observation and octreotide), opioids and clonidine (pinpoint pupils, respiratory depression → naloxone), and methyl salicylate. In agricultural organophosphate (pesticide) poisoning — a cholinergic syndrome treated with atropine and pralidoxime.
Key points
- ABC, glucose, dose per kilogram, poison information centre.
- Paracetamol: level at 4 hours and NAC according to the nomogram.
- Iron above 60 mg/kg is dangerous; deferoxamine in severe poisoning.
- Caustic: no emesis, no neutralisation, endoscopy if symptomatic.
- "One pill can kill": tricyclics, calcium and beta blockers, sulfonylureas, opioids, clonidine.
Summary table
| Agent | Picture | Targeted test | Treatment |
|---|---|---|---|
| Paracetamol | Few symptoms at first; liver injury after 24–72 hours | Level 4 hours after ingestion, nomogram | NAC, most effective within 8 hours |
| Iron | Vomiting, bloody diarrhoea, "calm", then shock and acidosis | Abdominal X-ray, serum iron | Deferoxamine in severe poisoning; charcoal ineffective |
| Caustic | Drooling, stridor, vomiting, pain | Endoscopy in the first 12–24 hours when symptomatic | No emesis, no neutralisation, no charcoal |
| Opioids and clonidine | Drowsiness, pinpoint pupils, slow breathing | Clinical | Naloxone and respiratory support |
| Tricyclics | Seizures, arrhythmias, wide QRS | ECG | Sodium bicarbonate |
| Sulfonylurea | Hypoglycaemia, sometimes delayed | Repeated glucose | Glucose, octreotide, 24-hour observation |
A free exam question
באיזה מבין המצבים הבאים ניתן לטפל בעזרת פחם פעיל? (the question as examined, in Hebrew)
- א. הרעלת אלכוהול
- ב. הרעלת ברזל
- ג. הרעלת ליתיום
- ד. הרעלת אקמול
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Sources
- Management of Acetaminophen Poisoning in the US and Canada: A Consensus Statement, 2023 — Risk assessment and acetylcysteine
- AACT/EAPCCT Position Paper: Single-Dose Activated Charcoal, 2005 (update) — Indications and limitations
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Poisoning
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.
See also: in adults: Approach to the poisoned patient and toxidromes