Accidental Poisoning In Children Research Articles

General pattern of paediatric poisoning in Jordan during 2018–2019

IntroductionAcute accidental poisoning in children remains a significant public health issue and a predictable cause of morbidity around the world. To take preventive measures, it is necessary to identify the pattern of this problem. ObjectiveTo determine the extent and characteristics of paediatric poisoning, an epidemiological investigation specific to each country is required. The goal of our research was to determine the current pattern of acute poisoning in children between (0−5) years old in Jordan. MethodsThis retrospective study performs a descriptive analysis of the Jordan University Hospital’s National Poison Information Center (NPIC) database and describes the epidemiology of acute poisoning in children between (0−5) years old during a period of two years (2018–2019). ResultsPaediatric poisoning (0−5) years old accounts for approximately 88% of poisoning cases in Jordan between 2018 and 2019.Out of 3531 paediatric poisoning cases, 44.9% of cases were in children between (2−3) years old, 63.4% of subjects were male. 40.9% of calls were from governmental hospitals. Most cases occurred at home (98.7%) and were unintentional (98.6%). Medication poisoning was the commonest among cases (71.0%). Besides, 89.4% were asymptomatic at the time of call, and Central Nervous System (CNS) symptoms being the most common (3.6%) among the symptomatic cases. ConclusionsMost cases of paediatric poisoning handled by the NPIC was due to medications. To prevent or minimize these cases, it is necessary to educate parents and other caregivers about proper medication storage and use, and in case of poisoning, urgent referral to health facilities is required.

Epidemiological Profile of Accidental Poisoning in Children, Retrospective Study at Benghazi Children’s Hospital, Libya, 2021

Aims: This study aimed to determine the clinical and epidemiological profile, and outcomes of accidental poisonings in children.
 Study Design: This observational retrospective study.
 Place and Duration of Study: General ward and ICU of Benghazi Children's Hospital, from the 1st of January to the 31 of December 2021.
 Methodology: The study included 232 children up to 15 years old (131 males, 101 females) who were admitted with acute poisoning (either comatose or stable). Complete demographical, clinical, and outcomes data were recorded and analyzed using SPSS version 26.0 software.
 Results: out of 232 children admitted for poisoning 56% were drug poisoning, while 44% were non-drug poisoning. Children, less than 3 years were more liable for poisoning 61.2%. Males were poisoned more than females in all age groups 56.5%. The type of poisoning was found strong correlation with age and was higher in younger (P=.002), living in urban areas (P=.022). The results showed that there was a statistically significant difference between the types of drugs and age groups (P=.000). In almost all cases 93.1% were due to accidental/ unintentional poisoning. More than 88.3% of the cases were exposed to poisoning through the oral route. Overall, 29.3% of drug-poisoning children were asymptomatic, whereas all non-drug-poisoning children were symptomatic and most had mild symptoms. Most cases were discharged in good condition, and only one case died due to anti-psychiatric drug poisoning. 
 Conclusion: The findings confirm that children under 3 years are more prone to accidental poisoning. Antipsychiatry drugs and cannabis were the most commonly involved in the poisoning.
 Recommendations: Accidental toxic exposures could be avoidable by preventive measures. The cornerstone of management for children’s poisoning is appropriate public education and raising awareness among parents about safe practices of storing medications and toxic household chemicals.

Submucosal Haemorrhage in Celphos Poisoning: Postmortem Study and Chemical Analysis

Poisons are commonly involved in homicidal, accidental or suicidal cases. In India Aluminum Phosphide (ALP) is available as white tablet of Celphos commonly used as grain preservative. After ingestion on coming in contact with moisture ALP librates Phosphine gas (PH3) having pungent odour. The chemical reaction is accelerated by the presence of HCL in the stomach. Phosphine is rapidly absorbed from gastric mucosa by simple diffusion and cause damage to the internal organs. Several studies reported 100% necrosis of mucosa in ALP poisoning but still no specific antidote are available for it. ALP poisoning was found to be the major cause of death among all cases of poisonings. Several suspected visceral samples for detection of poison were examined in Forensic Science Laboratory, Bihar, Patna. The present study was conducted on those 25 visceral samples in which mucosal haemorrhage was reported in their postmortem finding and gave positive result in preliminary examination of Celphos. Other parameters such as age, sex, causes of consumption of poison (suicidal, homicidal or accidental) as mentioned in FIR was also studied. Chemical analysis was done using Thin layer Chromatography technique. Aluminium Phosphide was found positive in all 25 visceral samples. Aluminium Phosphide poisoning has become the commonest poison in most of the cases of suicidal consumption. In India Despite its alleged high toxicity ALP is frequently used as grain preservative, which can be replace by using old traditional medicinal techniques like Neem leaf(Azadirachta indica),Turmeric(Curcuma longa),Tulsi(Ocimum tenuiflorum)etc. Aluminium phosphide (ALP) poisoning (Celphos) has emerged as a common cause of accidental poisoning in children with mortality ranging from 37-100%.These pesticides should not easily available. Sale of poison should be control by strict law. Any negligent conduct with respect to poison resulting in damage to a person is punishable. Since, it has no specific antidote so management remains primarily supportive care. Toxicologists, Biotechnologists and other research scientists should work on such antidote that quickly counteract the effects of poison.

ACCIDENTAL DATURA POISONING IN A CHILD, A CASE REPORT FROM CENTRAL NEPAL

Datura stramonium is a common plant found all over Nepal. It contains alkaloids like atropine, hyoscyamine and scopolamine which can produce severe anti-cholinergic effects upon intoxication. It is mostly consumed during Mahashivaratri as a means of recreation and sacred blessing from lord Shiva. We would like to present a case of accidental poisoning in children by consuming sacred food mixed with D. stramonium during Mahashivaratri. Careful history taking and physical examination is important for early diagnosis. Presence of eye witness and early presentation to hospital contributes to favorable outcome. It may be more beneficial if we become more cautious and follow safety measures while performing cultural rituals and celebrating festivals. Also, we need to be aware of the possible fatal complications of Datura poisoning.

Accidental poisoning in children: a single centre case series study in Bangladesh

BackgroundAccidental poisoning is a leading cause of unintentional injuries among children in low-income and middle-income countries (LMICs). The overall aspect of this unintentional poisoning is poorly understood in Bangladesh. The...

Spectrum of Poisoning and Outcome among Children in a Tertiary Hospital, North-East Nigeria: A 20 Years Restrospective Review, 2000-2019

Introduction: Acute poisoning in children is cause of hospitalization and death worldwide. It is a Paediatrics emergency with significant economic cost. There are epidemiological differences in acute poisonings in children evaluated in Emergency departments across different countries and regions of the world. The aim of this study was to determine the causes of poisoning in children in our health facility during the period 2000-2019. Methodology: Case notes of children 6 months to 18 years managed for acute poisoning from January 2000 to December 2019 at Paediatrics unit, Federal Teaching Hospital Gombe (FTHG), were analysed. The International classification of Disease ICD 10 was used. Ethical Clearance was obtained. Results: 26,716 children were admitted with 76 cases of Acute poisoning giving a prevalence rate of 2.8/1000 children. 56.6% (43) were males. 63.2% (48) of children were years of age. 69.7% (53) were urban dwellers and 59.2% (45) from low socioeconomic class. 52.6% (40) of poisoning occurred in rainy season. 97.3% (74) of children had unintentional poisoning. Organophosphates 22.3% (17) and kerosine 22.3% (17) were the most common substances ingested. Snake-bite and corrosive ingestion occurred in 13.1% and 11.8% of children respectively. Ingestion was the route in 84.2% of cases. 75.0% (57) of poisoning occurred at home. ACP occurred in children aged 1 - 5 years (p-value = 0.025); More in Children from low socioeconomic status (p-value = 0.001) and urban settings (p-value = 0.001). There was no statistically significant relation between type of poisoning and gender p = 0.839, season p = 0.608, religion p = 0.504 and ethnic background p = 0.342. 4.2% (3) children died each from organophosphate, snake bite and tramadol poisoning. Conclusion: Kerosine and organophosphate were the leading cause of accidental childhood poisoning.

Toxin-Related Acute Kidney Injury.

Clinical Background: Nephrotoxic acute kidney injury or toxin-related acute kidney injury (ToxAKI) is a relevant and relatively common category of kidney damage. Exogenous toxins and venomous animals with epidemiologic variations across the world are some nephrotoxic agents. Epidemiology: The epidemiologic features of the toxic agent-related acute kidney injury are associated with different culture, biodiversity of the tropics, and economic status. It seems economic status is the major factor which defines the etiology of ToxAKI. In developing countries, the AKI is commonly associated with self-poisonings by pesticides and herbicides, while developed countries often notify poisonings due to antibiotics, nonsteroidal anti-inflammatory drugs, immunosuppressants (such as methotrexate), and iodinated contrast media. Moreover, envenoming due to snakes, spiders, and scorpions is more frequent in tropical regions. Challenge: Poisoned patients are more susceptible to renal impairment associated with renal replacement therapy and death. Prevention and Treatment: Preventing patient exposure and performing early diagnosis are crucial to beat the main causes of ToxAKI and further complications. Renal replacement therapy may be necessary to manage the patient, and it is associated with poor prognosis and death. According to each poisoning profile, specific measures are suggested. School-base interventions, early identification, treatment, and care of people with mental and substance use disorders, reducing access to chemical agents, making parents aware of the hazards of accidental poisoning in children, and maintaining fully functional poison control centers are vital actions too.

Changing Trends of Accidental Poisoning in Children over the Last Two Decades.

Changing Trends of Accidental Poisoning in Children over the Last Two Decades.

Societal issues and policy implications related to the use of cannabinoids, cannabis, and cannabis-based medicines for pain management.

Societal issues and policy implications related to the use of cannabinoids, cannabis, and cannabis-based medicines for pain management.

Accidental childhood poisoning in Paediatrics department of a tertiary care facility: A retrospective review

Background: Accidental childhood poisoning is a recognized preventable cause of morbidity and mortality among children worldwide. This studywas aimed at determining the prevalence, pattern, and outcome of childhood poisoning among children in Abakaliki, Ebonyi State.
 Material and Methods: Medical records of all cases of accidental childhood poisoning admitted into Children’s emergency room (CHER) of the health facility of study between January 2014 and December 2018 were retrospectively identified and relevant data extracted and analyzed usingSPSS version 22.
 Results: Out of the 7,700 children that presented to CHER over a 5- year period, 42 were cases of poisoning, giving prevalence rate of 0.5%. Of the 42 cases, only 20 case notes were retrieved. The male to female ratio was 2.3:1 while the ages ranged between 6months and 14 years with the mean age of 3.06±2.88. Kerosene poisoning had the highest proportion of 50.0% (10/20) with the overall mortality rate of 5.0% (1/20).The relationship between age, place of residence and outcome in poisoned children was statistically significant (p = 0.038, 0.045 respectively).
 Conclusion: Accidental childhood poisoning is common in Abakaliki. Kerosene still remained the major agent while male toddlers were most vulnerable. There is need to intensify enlightenment campaigns and education of the public about the hazard of improper storage of kerosene and other implicated substances at home.
 Keywords: Accidental poisoning, Childhood, Kerosene

A Rare Case of Podophyllin Poisoning: Early Intervention is Lifesaving.

ABSTRACTAccidental poisoning in children is very common, making up 10.9% of all unintentional injuries worldwide. Africa has the highest incidence of fatal poisonings worldwide, at 4 per 100,000. Poisoning with podophyllin is rare, with most cases documented around the 1970s to 1980s. Podophyllin is a resin mixture obtained from the dried Rhizome and roots of Podophyllin peltatum (North America) and Podopyllin emodi (India). Podophyllotoxin is the most toxic chemical present in the podophyllin, which is lipid soluble; so crosses the cell membrane easily and inhibits mitotic spindle formation. Both topical application and oral consumption can cause podophyllin poisoning. Neurotoxicity is the most serious effect along with bone marrow depression, gastrointestinal irritation, and hepatic and renal dysfunction. Management of podophyllin toxicity is mainly symptomatic, and no specific antidote exists. We report a case of a 2-year-old-year girl with accidental podophyllin poisoning, who presented with neurotoxicity followed by multiorgan dysfunction and then succumbed. Education of parents and healthcare workers on home safety still remains the mainstay of prevention.How to cite this article: Jain MK, Patnaik S, Rup AR, Gaurav A. A Rare Case of Podophyllin Poisoning: Early Intervention is Lifesaving. Indian J Crit Care Med 2020;24(6):477–479.

Study of clinical profile of accidental poisoning in children

Background: Accidental poisoning is an important cause of morbidity and mortality in children. Poisoning is one of the medical emergencies encountered in the emergency department. Accidental poisoning is common in toddlers and pre-school children. Aim of this study was to determine the agents of poisoning and demographic distribution of children brought to Rajarajeswari Medical College and Hospital with a history of accidental poisoning.Methods: The study method was descripitive study done in pediatric department at Rajarajeswari Medical College and Hospital for 18 months, from 1 December 2017 to 31 May 2019. 25 cases were of accidental poisoning. Data was analysed by statistical analysis.Results: The prevalence of accidental poisoning was 0.1%. There was male preponderance, 16 cases were male (64%) and 9 were female (36%), hydrocarbon (40%) was the most common household agent causing poisoning, followed by pyrethroid (24%), followed by NSAID’S (8%). Most common symptom was vomiting. The mean time elapsed to reach hospital was 97.80 minutes. In majority of the cases, hospital stay was for 2 days in (13 cases (52%)).Conclusions: Children become victims of accidental poisoning. Most common agents of poisoning are household products and medications.

Status of clinical toxicology education and ethics in medical care of poisoned patients in the Islamic Republic of Iran and a comparison with other countries.

Clinical toxicology is not recognized as a clinical speciality in Iran. After the chemical war gas attack by the Iraqi army against the Iranian troops in the 1980s, health professionals and Iranian authorities noticed the importance of this field in clinical medicine. Collaboration between the clinical toxicologists and toxicologists of pharmacy schools resulted in the establishment of the Iranian Society of Toxicology and Poisonings in 1991 and the National Board of Toxicology in 1993. Clinical toxicology fellowship was also formed as a joint collaboration between the toxicology and internal medicine boards in 2010. Medical doctors who specialized in clinical medicine are eligible to take the entrance examination of the fellowship. In spite of the advancement of clinical toxicology and increased number of acute poisonings and drug abuse, undergraduate teaching in this field is still lacking and being taught as part of the forensic medicine curriculum since 1952. There is a lack of an efficient national poison information and control centre (s) in Iran, and no action plan and practical efforts have been done for poisoning prevention. Therefore, the number of drug abuse and acute poisonings has increased over the past four decades and induced cultural, social and health problems. According to Iranian legal medicine organization reports, poisoning is the second-most occurring cause of unnatural death. The suicidal attempt is the most common method of acute poisoning in adults. Suicidal attempt including self-poisoning is not accepted in the Islamic point of view, and thus self-poisoning is mostly neglected and may not be treated appropriately in time in some regions of Iran. Accidental poisoning in children is also common in Iran and estimated to be between 20000 and 25000 cases annually over the recent years. In addition, social, cultural and economic problems have induced more health problems such as drug abuse and addiction even in children. Adulterated opium to lead for economic gaining has produced thousands of cases of lead poisoning over the past few years in nearly all opium addicts, which is still a major health problem in Iran. Ban on alcoholic beverages leads some people to make their own home-made spirits, which is unfortunately contaminated with methanol. Thousands of cases of methanol poisoning and even some epidemics have occurred over the past four decades in some parts of the country. Lack of availability of essential antidotes such as succimer and fomepizole has been a major problem for the effective treatment of poisoned patients. Despite the well-known fact that cases of poisoning and drug overdose constitute a significant proportion of hospital admissions in some developing countries, clinical toxicology education and medical care of the poisoned patients are lacking. Therefore, policymakers and health authorities should realize the importance of toxicology in clinical medicine. The Iranian Ministry of Health, medical care and Medical Education should implement clinical toxicology courses for medical students; establish effective national poisons information and control centres and advance clinical toxicology services for appropriate management of poisoned patients to improve public health and the overall health policy goals.

Amitraz, an unusual poison

Accidental poisoning in children is a common pediatric emergency. Here, we report the case of a 7-year-old girl with Amitraz poisoning. Ingestion and dermal contact with a dissolved solution of Amitraz lead to acute toxicity, which mimicked organophosphate poisoning. The patient lost consciousness which prompted their presentation to the pediatric emergency department. Limited literature is available regarding Amitraz poisoning. This case report attempts to document the findings and raise awareness to hasten identification and treatment of a rare and newer poison, Amitraz.

Profile of Accidental Poisoning in Children: Studied at Urban Based Tertiary Care Centre

Profile of Accidental Poisoning in Children: Studied at Urban Based Tertiary Care Centre

Liquid Mosquito Repellent Ingestion in Children.

Hydrocarbons are a common cause of accidental poisoning in children, with kerosene being the most implicated agent in rural parts of India. However, lately, liquid mosquito repellent ingestion is emerging as an important cause of hydrocarbon (kerosene) poisoning in urban households. This is a retrospective case series over a 5-y period (January 2013 - December 2017) of children with accidental liquid mosquito repellent ingestion presenting to the pediatric emergency. Epidemiology, clinical profile, management and outcomes are discussed. Twenty-three children with median (IQR) age of 24 (18.8-32) mo presented after mean (SD) interval of 6 (3) h from ingestion. Majority (20, 87%) were seen during summer months (March-June) and all were from urban background. Sixteen (70%) had mild-moderate acute respiratory distress syndrome (ARDS) requiring supplemental oxygen with or without positive airway pressure for a mean (SD) duration of 3.3 (1.9) d. All except one survived. Children with accidental liquid mosquito repellent ingestion had predominant aspiration pneumonitis due to hydrocarbon content rather than neurological complications attributable to synthetic pyrethroids. Ensuring child-proof containers, appropriate storage, regulatory surveillance and parental awareness are must for prevention.

What Have Been the Public Health Impacts of Cannabis Legalisation in the USA? A Review of Evidence on Adverse and Beneficial Effects

To summarise empirical research on the adverse and beneficial public health impacts of cannabis legalisation in states in the USA. The most consistent finding from surveys of drug use is that the legalisation of medical cannabis has so far not had an effect on rates of use or cannabis use disorders among youth, but it has increased the frequency of use among adult cannabis users. There are conflicting findings on the impact of legalisation of medical and recreational cannabis use on the following: cannabis use disorders in adults, rates of motor vehicle accidents in which the driver was impaired by cannabis, rates of suicide, and opioid-related harms. The legalisation of recreational cannabis use has increased emergency room attendances for cannabis-related medical conditions (acute adverse psychological effects, hyperemesis, and accidental poisoning of children). There is no evidence to date on the impact of medical or recreational legalisation on the prevalence of mental disorders such as psychoses, depression, and anxiety. There is suggestive evidence that cannabis legalisation is associated with a range of public health consequences. However, current evidence is limited in the capacity to confidently conclude that these changes are the result of cannabis legalisation. The impacts on public health may take some years to become apparent.

Electronic cigarettes in the indoor environment.

The use of electronic cigarettes (e-cigarettes or "vaping") has seen an unprecedented increase worldwide. Vaping has been promoted as a beneficial smoking cessation tool and an alternative nicotine delivery device that contains no combustion by-products. However, nicotine is highly addictive, and the increased use of nicotine-containing e-cigarettes among teens and individuals who are not in need of smoking cessation may lead to overall greater nicotine dependence in the population. Furthermore, available research indicates that vaping solutions and their emissions may contain much more than just nicotine, including aerosolized flavorings, propylene glycol (PG), and other intentional and unintentional contaminants. These materials could present undefined potential health hazards to both e-cigarette users and bystanders, the full extent of which is not well understood at this time. Whereas e-cigarette usage and exposures may lower some or most of the risks associated with conventional cigarette use, the health effects of nicotine and aerosol exposures from e-cigarettes are not well understood. Research indicates that vaping aerosols are not benign, especially for nearby people in areas with limited ventilation and people with compromised health conditions. In addition, e-juice liquids have already been responsible for an increase in accidental poisonings in children. Because the magnitude of health and safety hazards that vaping may present to nonusers remains unclear, it is prudent to manage and control vaping in indoor locations where smoking is currently restricted. Based on a review of current scientific information, the American Industrial Hygiene Association (AIHA) recommends that e-cigarettes should be considered a source of aerosols, volatile organic compounds (VOCs), and particulates in the indoor environment that have not been thoroughly characterized or evaluated for health risk or safety.

Kerosene, Camphor, and Naphthalene Poisoning in Children.

ABSTRACTKerosene poisoning is one of the most common accidental poisoning in children in developing countries due common use of kerosene in house-hold and unsafe storage practices. Aspiration pneumonitis is the most common manifestation of kerosene ingestion due to its low viscosity, high volatility, and low surface tension. The treatment of aspiration pneumonitis due to kerosene poisoning is symptomatic including oxygen support, respiratory monitoring, and careful monitoring of fluid balance. Children with severe respiratory distress and hypoxemia unresponsive to supplemental oxygen and/or severe central nervous system involvement require early intubation and mechanical ventilation. Transfer to the pediatric intensive care unit (PICU) is required at this stage. Emesis, gastric lavage, and administration of activated charcoal are contraindicated due to risk of aspiration. There is no clear benefit of using corticosteroids or prophylactic antibiotics. Asymptomatic children should be kept under observation for atleast 6 hours after exposure. The mortality rate is low and death occurs due to pneumonitis. Camphor is used in house-hold items including vaporized or topical cold preparations, liniments, moth repellents, for performing rituals in religious ceremonies, and in antimicrobial preparations. Camphor poisoning is not very common in childhood. Even small doses of camphor can cause serious toxicity and is potentially fatal. The onset of action is very rapid (5–15 minutes). The common manifestations are confusion, restlessness, delirium, and hallucinations, muscle twitching, myoclonus, ataxia, hyperreflexia, fasciculations, and seizures. Seizures are common and serious complication in camphor toxicity. The treatment is supportive including decontamination, gastric lavage, activated charcoal, and seizure control. Naphthalene is a major constituent of mothballs which are commonly used in household to protect clothes from moths. Though the poisoning with naphthalene is uncommon in children, most of the cases with naphthalene poisoning occur in developing countries where mothballs are still commonly used. The manifestations of naphthalene toxicity are predominantly due to acute intravascular hemolysis leading to anemia, hemoglobinuria, methemoglobinemia, and acute kidney injury (AKI). The treatment of naphthalene toxicity is supportive in form of transfusion of the packed red blood cells, monitoring of fluid and electrolyte balance, administration of alkalis in presence of hemoglobinuria, and renal replacement therapy. Prevention is better than cure. The strategies should be adopted to prevent children being exposed to these toxic compounds in the house-hold. Safe storage of toxic compounds away from the reach of children, avoiding storing kerosene in cold drink and beverage bottles, community education, provision of electricity in rural areas, safe cooking practices, and parental supervision are important interventions to prevent accidental poisoning among children.How to cite this articleKumar S, Kavitha TK, Angurana SK. Kerosene, Camphor, and Naphthalene Poisoning in Children. Indian J Crit Care Med 2019;23(Suppl 4):S278–S281.

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.