Accidental Poisoning In Children Research Articles

Epidemiological study on accidental poisonings in children from northeast romania.

Accidental poisonongs are an important cause of morbidity and even mortality, especially in young children.We performed a retrospective observational study on a group of children admitted at the Regional Center of Toxicology at the Children's Emergency Hospital “St. Mary” Iasi with accidental intoxication within a period of 3 years. Data were collected from patients’ files and processed with a SPPS 18.0 database and a 95% confidence interval.During this period, 480 children were admitted with accidental intoxication. Most of them were in the age group of 1 to 2 years (120 cases—24.3%). The etiology of these intoxications was dominated by nonmedication (67%), the most frequent being household chemicals, carbon monoxide, and insecticides. Accidental drug intoxication accounted for 33% of the cases, the main drugs involved being anticonvulsants, nonsteroidal anti-inflammatory drugs, and paracetamol. The mortality caused by accidental poisoning was 0.62%, all deaths owing to nonmedication intoxication.Identifying the epidemiological and evolutionary aspects of accidental intoxications must be a major objective for the health system, given that this pathology can be at least partially avoided and its incidence and severity may be reduced using appropriate measures.

Caregivers’ Knowledge and Perception of Accidental Childhood Poisoning in Selected Hospitals in South-South Nigeria

Background: Accidental poisoning is a monumental challenge internationally and a major cause of morbidity and mortality among children in Nigeria. There is a paucity of data on the knowledge and perception of primary caregivers with regards to accidental childhood poisoning in the study locale. This study sets out to ascertain these so as to aid the development of suitable educational programmes. Objective: To assess the knowledge and perception of accidental childhood poisoning among caregivers of under-five children in Edo and Delta States of Nigeria. Methods: The study subjects included caregivers with children less than five years of age attending the Well-baby Clinics of four major hospitals in Edo State and Delta States, South-south Nigeria, between February and April 2016. A structured questionnaire served as an instrument to extract information on their biodata and their knowledge and perception of accidental childhood poisoning. Results: Of the 632 caregivers studied, 38.8%, 36.2% and 25.0% had low, moderate and high levels of knowledge of accidental childhood poisoning respectively. The primary caregivers had poor knowledge on first aid following ingestion of a poisonous agent as the majority (90.2%) of them responded that palm oil is a good antidote for most poisons. The higher the level of education of the caregiver, the more likely it is that she would possess the correct knowledge on childhood poisoning and its prevention. The level of perception of accidental childhood poisoning among the caregivers was positive in 447 (70.7%) and negative in 185 (29.3%). The caregivers had the negative perception to some specific statements on the scale; for instance indicating that it is safe to take one's medicines in the presence of the young child. Conclusion/Recommendation: Caregivers with a high level of knowledge were few. The need for public enlightenment programmes on poisoning prevention, on appropriate first aid should poisoning occur, as well as disabusing caregivers’ minds of certain negative perceptions of accidental childhood poisoning are again emphasized. The establishment of Poison Control Centres (PCCs) to aid in the achievement of this goal would be a step in the right direction.

Clinical profile and outcomes of childhood poisoning

The patterns of accidental poisoning in children usually differ from country to country and from one region to another within the same country. This retrospective study was performed from January 2012 to December 2014 to determine the trends of childhood poisoning in urban area of Bangladesh. A total of 32 cases were analyzed completely; intention of poisoning was classified as accidental, suicidal and homicidal. The commonest age range for accidental poisoning was 1-5 years (64.7%). Suicidal poisoning was prevalent among mid adolescence group. The overall male to female ratio was 1:1; in case of accidental poisoning male to female ratio among preschooler was 2.66:1. All the patients were from urban background and drug overdose was the commonest cause of poisoning. Accidental poisoning was found in 53% of patients, suicidal 41% and homicidal 6% cases. The mortality was 3%. This study showed that boys at pre-school age group were at greater risk for accidental poisoning. Drug over dosage was the most common poisoning in this study. Alarmingly, accidental introduction of per rectal analgesic was the most common cause of acute poisoning during infancy in this study.

Accidental Poisoning in Children – At Tertiary Care Unit

Accidental Poisoning in Children – At Tertiary Care Unit

ASCORBIC ACID AS AN EFFECTIVE ALTERNATIVE FOR TREATMENT OF DAPSONE POISONING IN A CHILD: A CASE REPORT

Dapsone (DDS – Diamino diphenyl sulfone), a sulfonamide derivative acts by inhibiting PABA incorporation into folic acid. It is commonly used in treating skin diseases. Accidental poisoning in children is uncommon. It results in methaemoglobinemia by causing oxidative stress. Principle of treatment relies on treating methemoglobinemia by using reducing agents like methylene blue or ascorbic acid. Due to the long half-life, dapsone provides a continuing oxidative stress that can cause a recurrence of clinically significant methaemoglobinaemia and hence takes long to treat. Ascorbic acid is effective in treating methemoglobinemia associated with dapsone poisoning as demonstrated in this case report of a four and half year old child’s accidental ingestion of dapsone tablets and presenting with cyanosis. The child was managed successfully with ascorbic acid and supportive treatment.

Accidental poisoning in children with special reference to kerosene poisoning.

A 6-year (1970- 1975) retrospective study of kerosene poisoning in children admitted to the General Hospital, Medan, is presented. The total number of admission was 10.643, 124 of which were kerosene poisoning. Tho mortality was 4.8%. In North Sumatera the incidence of kerosene poisoning along with the consumption of kerosene showed an increasing trend. The male to female ratio was 75 by 49 (3:2). The majority of cases were brought to the hospital within one hour after ingestion of kerosene. The presenting symptoms in the majority of cases were coughing (78.8%), vomiting (48.9%), dyspnoe 29%, fever 20.9%, brochopneumonia 12.9%, cyanosis 4.0%, and shock 1.6%. Treatment consisted of broad spectrum antibiotics, intravenous fluid, and oxygen administration. Kerosene in the household of the patients was used as fuel, either for cooking, or light source. More than 75% of the cases belonged to the lower socioeconomic class.

Clinical profile and outcome of acute poisoning in children and adolescent in a tertiary care center

Background: Childhood poisoning is a significant public health problem. It is a common worldwide health problem and a preventable cause of morbidity and mortality. Epidemiological studies on accidental poisoning in children show a consistent pattern with respect to sex and age.Aims and Objectives: To determine the changing pattern of clinical profile and outcome of acute poisoning in children and adolescent. Materials and Methods: All children aged 1-18 years with h/o poisoning, attending pediatric and medicine emergency department of College of Medicine and Sagore Dutta Hospital, Kolkata from March 2014 to February 2016 were the subjects of our study. Profiles of all cases and their outcome were noted.Results: Seventy-five patients were presented with acute poisoning during our study period. Majority of the children were between 12 to 18 years (45 cases, 60%). Most of the patients were residents of urban areas. Most frequent agents were drugs (44%), hydrocarbon (21.33%) and insecticides (22.66%). Almost all cases in 1-6 years age group were accidental in nature.Conclusion: Poisoning in children and adolescents are common problems. Incidences of acute poisoning in childhood remained more or less unchanged temporally. Poisoning by agents like drugs and organophosphorus compounds are alarming phenomena and these occur mostly during adolescence. Free availability of these compounds, co-morbid conditions of adolescents and adolescent stressors have to be addressed in this respect. Asian Journal of Medical Sciences Vol.8(3) 2017 76-80

Probuphine® (buprenorphine implant): a promising candidate in opioid dependence.

Opioid dependence leads to physical dependence and addiction which finally results in profound medical, psychological and social dysfunction. One of the useful medications for opioid dependence is buprenorphine, the partial opioid agonist, which is used alone or in combination with naloxone. However, buprenorphine is the victim of its own success due to its illicit use and accidental poisoning in children. Also, buprenorphine typically requires daily self-administration and its effectiveness heavily depends on patient adherence. So, poor treatment adherence results in ineffective treatment manifesting as craving and withdrawal symptoms. Short-term use of buprenorphine in opioid dependence is also often followed by relapse. Buprenorphine when used sublingually often results in inadequate or fluctuating blood concentrations and poorer treatment retention compared with methadone. All of these led to the development of Probuphine®, a polymeric matrix composed of ethylene vinyl acetate and buprenorphine in the form of implants, that are implanted subdermally in office practice and deliver the active drug over 6 months. Buprenorphine release from such implant is fairly consistent, avoiding plasma peaks and troughs, and the implant is also reported to be safe. In this review article, we have highlighted these aspects of treatment of opioid addiction, stressing on the pharmacology of buprenorphine and Probuphine®, and relevant clinical trials addressing the efficacy and safety of Probuphine®. This sustained-release implantable formulation of buprenorphine has the potential to be a suitable alternative to daily or alternate day sublingual buprenorphine which can thereby eliminate the need for daily supervision, minimizing fluctuations in plasma concentrations, and allowing these patients to reduce clinic or pharmacy visits.

Accidental organophosphate poisoning in a child in Uyo, Nigeria: a public health alert

<p class="abstract"><span lang="EN-US">Organophosphates are often constituents of pesticides and insecticides. Some of these products are sold by unregistered vendors on the streets and in market places in sub-Saharan Africa. When purchased, and improperly stored, children may easily have access to, and inadvertently consume them. The clinical features of organophosphate poisoning include diarrhoea, diaphoresis, urination, miosis, bronchorrhoea, bronchospasm, bradycardia, emesis, lacrimation and salivation. Atropine administration is an important cornerstone of the management of this condition, with a good outcome in this instance. A case of organophosphate poisoning is herein reported to illustrate the effect of the predisposing factors to accidental childhood poisoning. It is hoped that this will help make an urgent case to raise public awareness on the prevention of accidental childhood poisoning, as well as the enforcement of regulations on the production, labeling, distribution and sale of these organophosphate compounds.</span></p>

Epidemiology of paediatric poisoning reporting to a tertiary hospital in Ghana

Background. Childhood poisoning is an important cause of morbidity in both developed and developing countries. Epidemiological studies on accidental poisoning in children show a consistent pattern regarding age and gender. Childhood poisoning is predominant in children <6 years of age and has a male preponderance, as boys are more active with a drive to explore the environment. Objective. To document the epidemiology of home poisonings in Kumasi and its environs. Methods. We conducted a retrospective study from January 2007 to January 2012 at the Komfo Anokye Teaching Hospital, a tertiary hospital in Ghana. Results. Poisoning is a significant health problem in the study area. A total of 253 children reported to the hospital with poisoning over the 61-month period, with an average of four cases per month. The male to female ratio was 1.58:1. The median age of the children was 24 months (interquartile range 24 - 48 months). Kerosene was the leading cause of poisoning (39.5%). Conclusion. Paediatric poisoning is a major health hazard in children living in Kumasi and its environs. This can possibly be attributed to a lack of adequate supervision of children and poor storage of harmful substances in homes. Multidisciplinary interventions are needed to reduce the occurrence of the condition in the population at risk.

In response: Government perspective.

In response: Government perspective.

Accidental Childhood Poisoning in Enugu, South-East, Nigeria.

Background:Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time.Aim:This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu.Subjects and Methods:This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South-East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted.Results:Sixty-five cases of childhood poisoning were recorded during the 10-year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65).Conclusion:Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications.

Clinical presentation, treatment and outcome of acute dettol poisoning in children

Background: Despite various statutory warning, accidental ingestion of poisonous substances by children remains a major challenge to clinicians working in a tertiary care hospital. Accidental ingestion of dettol, a common household disinfectant is one among them where the clinical presentation was found to vary according to the amount ingested. This study was aimed to understand the clinical profile of accidental ingestion of dettol (AID), its treatment and outcome. Methods: A descriptive study was conducted in children, who admitted with special reference to AID in the paediatric intensive care unit (PICU) between January, 2010 and December, 2015. A standard performa which included age, sex, time of presentation to PICU after ingestion, clinical presentations, treatment given and the outcome were taken. Results: Among 5806 children admitted during the study period, 401 (6.9%) were due to acute poisoning. About 62 poisonous substances were identified. AID was found in 5/401 (1.2%) cases. Nausea, vomiting with burning sensation of oral mucosa, and abdominal pain were the symptoms when ingested a small amount (10-20 ml) of dettol. Stomach washing and antiemetic were the first line therapy. No mortality was evidenced from AID. Conclusions: Nausea, vomiting with burning sensation of oral mucosa, and abdominal pain were the clinical presentations of AID at mild quantity ingestion which were effectively managed by stomach washing and antiemetic therapy. Though AID was a rare accidental poisoning in children, it can be completely prevented by educating the society to keep the poisonous substance out of the reach of children.

Intentional and accidental paracetamol poisoning in childhood - a retrospective analysis.

Paracetamol is one of the most commonly used analgesics and antipyretics available without limits as preparations of the OTC group (over the counter drugs). Overdose and poisoning with this drug always brings about the risk of acute hepatic failure. The objective of the study was a retrospective evaluation of patients hospitalized in the Paediatric Clinic during the period 2004-2012 due to poisoning with paracetamol. The analysis covered 44 patients hospitalized in the Paediatric Clinic during 2004-2012 due to poisoning with paracetamol. Patients were divided into three groups: intentional poisonings, accidental poisonings, and drug overdose. During the period of the study, 44 patients aged 2.1-17.1, poisoned with paracetamol, were hospitalized. Among these patients there were 30 (68.2%) cases of intentional poisonings, 10 (22.7%) of accidental poisonings, and only 4 patients (9.1%) were children hospitalized after a paracetamol overdose. The majority of patients in all groups were females (93.3%). Paracetamol intoxication may occur after exceeding a single allowable dose, in the case of intentional poisoning, more rarely after exceeding the daily dose, in the case of intense pain complaints, or in the treatment of persistent fever. Based on the analysis performed, an increase was observed in the frequency of poisoning with paracetamol, especially intentional poisoning. Unlimited access to paracetamol as an OTC drug should be reconsidered.

Accidental podophyllin poisoning in a 3-year-old child

Accidental poisoning in children remains a common presentation in healthcare centres worldwide, with the highest rates of fatal poisonings occurring in Africa. Podophyllin, commonly used for genital warts, is a rare agent in poisoning cases. A few cases have been reported in the international literature, with serious systemic and neurological side-effects. We report a case of accidental podophyllin poisoning in a 3-year-old boy, which was complicated with organ dysfunction. The case highlights the severe neurological side-effects of podophyllin poisoning and the importance of accident prevention in our communities.

English

INTRODUCTION: Acute accidental poisoning in children is a big problem anywhere in the world. Studies done elsewhere in India showed a wide range of incidence of the problem. Hence, it was felt important to study its magnitude and associated characteristics as of now. OBJECTIVE: The current study was taken up to know the magnitude among children admitted in JNIMS, Imphal which is a newly established medical institute and also to study the characteristics like age, gender, type of poison, duration of hospital-stay and outcome of the cases. MATERIALS & METHODS: Retrospective data of all acute accidental poisoning cases among children admitted in the Pediatrics Ward, JNIMS, Imphal during the period July 2008 - December 2013 were analyzed by using descriptive statistics. RESULT: Of all the 13,663 children admitted, 148 cases were because of acute accidental poisoning giving an incidence rate of 1.08%. The male is to female ratio was 1.31:1. The last three years of the study period showed a slightly increasing trend in the incidence. Children aged 1-4 years were the most commonly affected (65.54%). Kerosene oil was by far the commonest (42%) of all the poisonous substances consumed. Food poisoning, poisoning with organic compounds, poisoning with medicinal drugs and poisoning with corrosives comprised 21%, 12%, 9% and 8% respectively of all the cases. There was no mortality. DISCUSSION: The incidence rate of 1.08% as found out from the current study was on the lower side as compared to reports of previous studies done in other parts of the country. Yet, it was two-fold of the incidence reported from RIMS which is situated in the same State. Parental negligence in storing poisonous substances in the household was implicated. They need to be made aware for keeping harmful poisonous substances in safe places out of the reach of children. CONCLUSION: Community-based studies are recommended for estimating more accurately the magnitude of the problem in the State.

FACTORS LEADING TO ACUTE ACCIDENTAL POISONING AMONG CHILDREN PRESENTING IN PEDIATRIC EMERGENCY OF A TERTAIRY CARE HOSPITAL

Objective: To determine the frequency of risk factors leading to acute accidental poisoning in children presenting in emergency of a tertiary care hospital.&#x0D; Material and Methods: This study was conducted from 20th April 2012 to 19th Oct 2012 in Pediatric ward emergency, Jinnah Hospital, Lahore. There were 200 patients included in this study presented to emergency department with poisoning.&#x0D; Results: A total of 200 patients were included. Age ranged from 1 year to 8 years with a mean age of 3.49 years and standard deviation (SD) of ± 1.77 years. Majority patients were upto 5 years of age 82.5%(165) and the patients above 5 years were 17.5%(35). Male were predominantly involved 76%(152) and females were 24%(48). There was easy access to poison in 84.5%(169) of the cases. Most of the mothers were illiterate or had education less than middle 71%(142). There were 29%(58) mothers who had education more than middle. Large family size with 3 or more kids were 66.5%(133) and families with less than 3 kids were 33.5%(67). Those with poor socioeconomic status (income per month less than 8250 Rs) were 73.5%(147). There were 77.5%(155) mothers who did not had awareness about toxic effects of the poison. Storage at common places was in 88%(176). Common places of storage were: kitchen 38.5%(77), understairs 21%(42), bedroom 15.5%(31), bathroom 6.5%(13) and elsewhere (roof, floor etc) 6.5%(13). Mother’s distraction was found in 91.5% (183) of the cases.&#x0D; Conclusion: Male sex, age less than five years, easy access to poisonous substance, family size three or more kids at home, poor socioeconomic status, lack of maternal awareness about toxic effects of poison, storage at common places and mother’s distraction were factors leading to acute accidental poisoning in this study.

Pattern of Paediatric Poisoning - A 3 Year Retrospective Study in Krishna Institute of Medical Sciences, Karad, Maharashtra

Poisoning is a major problem in the paediatric population. The offending substances used vary from place to place. The present study was undertaken to determine poisoning in children with respect to age, sex, habitat, seasonal distribution, type of poison, outcome and manner of poisoning. This is a retrospective analysis of 3 years from Jan 2010 to Dec 2012 of all childhood poisoning cases admitted in Krishna Institute of Medical Sciences, Karad in the age group of 0 to 14 years. A total of 152 cases were studied with male to female ratio of 2.3:1. Most common age group involved was 10–14 yrs with the incidence being more common in rural areas (86.1%). Most common poisoning was animal bite (63.8%) followed by kerosene (7.8%) pesticide (6.5%), drug (3.2%) and other substance (18.7%) ingestion. Rainy season was found to be the most vulnerable period for poisoning. All cases were accidental except one which was homicidal in nature. There was a mortality rate of 0.65% whereas 4 cases were discharged against medical advice. As most of the cases were accidental in nature, so access prevention and health education campaign should be instituted to reduce the incidence of accidental poisoning in children.

Do parents in Saudi Arabia store medications safely?

Background and objectives: Safe storage of medications can prevent the accidental poisoning of children. How medications are stored in homes in the Saudi community is not known. The objective of this study was to assess the safety measures for drug storage that are employed by parents to avoid unintentional drug poisoning of children below the age of 6 years. Materials and methods: This was a cross-sectional survey study based on a validated question-naire created using the Survey Monkey online tool. Results: Ninety-three percent of the respondents did not store medications in secure and safe places such as locked boxes or locked drawers; however, more than half of the respondents (54.3%) stored medications at a level that was above the eye level of an adult. The majority of drugs (60.2%) were kept in the fridge; 45.9% were kept in kitchens, 45.1% in bedrooms, 8% in living rooms and 2% in bath-rooms. Thirty percent of the respondents stored medications in two places, and 10% stored medica-tion in three or more places. Eighty-nine percent disposed of unwanted medicines by throwing them in the trash, only 11% returned them to the pharmacy, and 11% flush them down the toilet. Conclusions: These results raise concerns about how drugs are stored and disposed of in the commu-nity. Additional community education and awareness programs regarding the safe storage of drugs in the home and the identification of useful and accessible methods of drug disposal are needed.

Aspiration toxicology of hydrocarbons and lamp oils studied by in vitro technology

Medical literature regularly reports on accidental poisoning in children after aspiration of combustibles such as lamp oils which usually contain hydrocarbons or rape methyl esters (RMEs). We aimed to analyze the toxic potential of alkanes and different combustible classes in vitro with regard to biologic responses and mechanisms mediating toxicity.Two different in vitro models were used, i.e. (i) a captive bubble surfactometer (CBS) to assess direct influence of combustibles on biophysical properties of surfactant film and (ii) cell cultures (BEAS-2B and R3/1 cells, primary macrophages, re-differentiated epithelia) closely mimicking the inner lung surface. Biological endpoints included cell viability, cytotoxicity and inflammatory mediator release. CBS measurements demonstrate that combustibles affect film dynamics, i.e. the surface tension/area characteristics during compression and expansion, in a dose and molecular chain length dependent manner.Cell culture results confirm the dose dependent toxicity. Generally, cytotoxicity and cytokine release are higher in short-chained alkanes and hydrocarbon-based combustibles than in long-chained substances, e.g. highest inducible cytotoxicity in BEAS-2B was for hexane 84.6%, decane 74% and hexadecane 30.8%. Effects of RME-based combustibles differed between the cell models. Our results confirm data from animal experiments and give new insights into the mechanisms underlying the adverse health effects observed.