Pediatric Poisoning Research Articles

Impact of COVID-19 lockdown on acute pediatric antipsychotic poisoning outcome in Tanta University Poison Control Centre

Background: Acute pediatric antipsychotic poisoning has obviously increased during COVID-19 lockdown. Minimal research concerning this topic were conducted in Egypt. Objectives: to identify the outcome predictors of acute pediatric antipsychotics poisoning during COVID 19 lockdown. Methods: The study was carried on children with acute antipsychotics poisoning admitted to Tanta University Poison Control center from (2019-2020). Recorded data were obtained from patients‟ files including sociodemographic characteristics, clinical examination, results of laboratory investigations, and ECG in addition to severity assessment by poison severity score. Results: A noticeable increase in the overall number of antipsychotic poisoned children was observed in 2020 than 2019. Additionally, the ingested doses, suicidal rates and the mean delay time were increased in 2020. Lower GCS ranging from 3-8 and 9-12 were more observed in 2020 compared to 2019. Atypical agents with minimal extrapyramidal manifestations were more commonly ingested. Hypotension and ECG changes particularly sinus tachycardia and prolonged QTc intervals were common in the studied sample and observed frequently in 2020 than 2019 cases. ICU admission rate together with hemodynamic instability increased in 2020 than that in 2019 however the length of hospital stay was nearly equal. Logistic regression analysis revealed that lower GCS and higher PSS were significantly accompanied by increased the likelihood of ICU admission. Conclusion: Severity of antipsychotic poisoning was higher during COVID-19 lockdown. Predictors of worse outcomes regarding ICU admission rates, neurological and cardiovascular toxicities were concluded.

Changes in Opioid Poisoning Pattern in Children: A Retrospective Study in Rasht, Iran

Background: Poisoning comprises about 7% of accidents in children under 5-year-old and 2% of all pediatric deaths in developing countries. To warn against and prevent future potential poisoning with opioid substances, this comparative study was conducted on pediatric cases referred to the 17th Shahrivar Hospital in Rasht, Iran, in 2006 and 2018. Methods: In this retrospective, cross-sectional study, all hospitalized pediatric cases diagnosed with opioid poisoning in 2006 and 2018 were investigated systematically. The demographic data, such as age, gender, city or village of residence, the poisoning substances involved, and the clinical outcomes were extracted from the medical records and entered on an appropriately-designed form. The data analysis was performed, using SPSS software, version 21. Results: Fifty pediatric cases were examined with a mean age of 44.38±3.8 months old. Among these cases, 14 children had been poisoned, 13 of whom with opium and one with morphine in 2006; while in 2018, 36 children had been poisoned with methadone and only one with opium. Conclusion: Comparing years 2006 with 2018, a considerable increase in pediatric opioid poisoning cases was observed with a tendency toward methadone being the substance involved. The occurrences might be due to unsafe access of unaware children to this drug, especially after the initiation of methadone maintenance treatment for opiate addicts, who were mainly the parents or relatives living in the same household.

Unintentional paediatric iron poisoning: A retrospective case series.

Iron poisoning is a historically important cause of paediatric morbidity and mortality. In recent decades, public health measures have considerably reduced paediatric iron exposures. We investigated unintentional paediatric iron poisoning in children with the aim of developing an assessment approach specific for this group. This was a retrospective observational study of unintentional iron poisoning in children (<7 years old) referred to either a state-wide poisons information service or a tertiary clinical toxicology unit from 1 January 2015 to 16 February 2020. Patients were identified from prospective databases maintained by both services, and data were extracted from these in addition to the medical record. There were 54 children included in the study (29 [54%] male; median age 2 years (range 8months to 4 years). The median suspected dose of elemental iron ingested was 72 mg/kg (IQR 41-140 mg/kg). Seventeen (31%) children were symptomatic. There were no cases of severe toxicity. Children symptomatic with gastrointestinal toxicity had a median suspected dose ingested of 60 mg/kg (IQR 38-150 mg/kg) that was similar to asymptomatic children (81 mg/kg [IQR 41-143 mg/kg], P= 0.809). The median peak iron concentration was 49 μmol/L (IQR 13.5-67.5μmol/L, range 4-75 μmol/L). Symptomatic children had a significantly higher median peak serum iron concentration of 66 μmol/L (IQR 54-68 μmol/L) compared to 12 μmol/L (IQR 9-15 μmol/L) in asymptomatic children (P< 0.001). Unintentional paediatric iron poisoning is uncommon and largely benign. Suspected dose ingested is a poor predictor of toxicity. Targeting investigations and interventions to symptomatic children should reduce unnecessary assessment and management while still safely managing the exposure.

Acute toxic exposures in children: analysis of a three year registry managed by a Pediatric poison control Center in Italy

IntroductionAcute pediatric poisoning is an emerging health and social problem. The aim of this study is to describe the characteristics of a large pediatric cohort exposed to xenobiotics, through the analysis of a Pediatric Poison Control Center (PPCc) registry.MethodsThis study, conducted in the Pediatric Hospital Bambino Gesù of Rome, a reference National Pediatric Hospital, collected data of children whose parents or caregivers contacted the PPCc by phone (group “P”), or who presented to the Emergency Department (group “ED”), during the three-year period 2014–2016. Data were prospectively and systematically collected in a pre-set electronic registry. Comparisons among age groups were performed and multivariable logistic regression models used to investigate associations with outcomes (hospital referral for “P”, and hospital admission for “ED”group).ResultsWe collected data of 1611 children on group P and 1075 on group ED. Both groups were exposed to both pharmaceutical and non-pharmaceutical agents. Pharmaceutical agent exposure increased with age and the most common route of exposure was oral. Only 10% among P group were symptomatic children, with gastrointestinal symptoms. Among the ED patients, 30% were symptomatic children mostly with gastrointestinal (55.4%) and neurologic symptoms (23.8%). Intentional exposure (abuse substance and suicide attempt), which involved 7.7% of patients, was associated with older age and Hospital admission.ConclusionsOur study describes the characteristics of xenobiotics exposures in different paediatric age groups, highlighting the impact of both pharmacological and intentional exposure. Furthermore, our study shows the utility of a specific PPCc, either through Phone support or by direct access to ED. PPCc phone counselling could avoid unnecessary access to the ED, a relevant achievement, particularly in the time of a pandemic.

Antidotes for childhood toxidromes.

BackgroundPoisoning causes significant morbidity and sometimes mortality in children worldwide. The clinical skill of toxidrome recognition followed by the timely administration of an antidote specific for the poison is essential for the management of children with suspected poisoning. This is a narrative review on antidotes for toxidromes in paediatric practice.MethodsA literature search was conducted on PubMed with the keywords “antidote”, “poisoning”, “intoxication”, “children” and “pediatric”. The search was customized by applying the appropriate filters (species: humans; age: birth to 18 years) to obtain the most relevant articles for this review article.ResultsToxidrome recognition may offer a rapid guide to possible toxicology diagnosis such that the specific antidote can be administered in a timely manner. This article summarizes toxidromes and their respective antidotes in paediatric poisoning, with an emphasis on the symptomatology and source of exposure. The antidote and specific management for each toxidrome are discussed. Antidotes are only available for a limited number of poisons responsible for intoxication. Antidotes for common poisonings include N-acetyl cysteine for paracetamol and sodium thiosulphate for poisoning by cyanide.ConclusionPoisoning is a common cause of paediatric injury. Physicians should be familiar with the recognition of common toxidromes and promptly use specific antidotes for the management of childhood toxidromes.

Pediatric opioid fatalities: What can we learn for prevention?

The aim of this study was to highlight 19 cases investigated by the North Carolina Office of the Chief Medical Examiner over the last 12years involving accidental or undetermined manner of death opioid ingestions leading to fatalities in young children. These pediatric ingestions have closely mirrored the opioid epidemic in adults transitioning from prescription medications to illicit drugs including fentanyl and fentanyl analogues. Unlike a typical adult ingestion for purposes of self-harm or pleasure, poisonings in toddlers and infants are usually the result of curiosity, exploration, a decreased sense of danger, or imitation of adult or older sibling behavior. Eleven of the decedents were between the ages of 8 and 24months. Among the cases were 12 prescription opioid exposure deaths and 7 illicit drug poisonings. A majority of the decedents were found unresponsive in an unkept home and/or in unsafe sleeping spaces with easy access to drugs or drug materials, which stresses the importance of safe pediatric sleeping conditions. After a complete pathological investigation, several of the cases had physical or scene evidence demonstrating that foil, plastic, or paper small enough to be ingested can contain enough potent opioid to cause death. Details from the toxicological investigation are included for each case to provide postmortem whole blood drug concentrations for forensic practitioners. Accidental pediatric poisonings are preventable. Risk reduction through improving awareness and education of the dangers of opioids is a key factor in mitigating these tragedies.

Prevalence and Related Factors of Pediatric Acute Poisoning In Iran: A Systematic Review and Meta-Analysis

Background: The epidemiology of pediatric poisoning differs from one country to another. Due to the scarcity of reviews on this issue in Iran, we performed this systematic review and meta-analysis study. Methods: In order to find relevant studies published between January 2002 to December 2020, Valid English and Persian databases, were searched, using the following keywords: prevalence, epidemiology, children, poisoning, intoxication, envenomation, Iran. Random effect models were used to estimate pooled prevalence and 95% confidence intervals (CIs). Findings: 30articles, with a total of 12,994 participants, were included in the meta-analysis. 54.7%, were male, and 88.1% of them were unintentional. The most children were in the age range of 3-5 years. 59.2 % of poisonings were due to Non-pharmaceutical agents (95%CI: 54.5-63.8, I2 =96.1%). Amon them, illicit drugs (19.3%) followed by hydrocarbons (16.4%) were more common. There was an increasing trend in illicit poisonings especially opioids from 8% (n=260) in 2002 to 44.9%(n=1670) in 2020. Among pharmaceuticals, Central Nervous System (CNS) drugs, responsible for 50.4 % of cases. Among symptoms, 51.8 % were CNS complaints. Ingestion was responsible for 22.1% of poisonings. There was a remarkable reduction in the rate of hospitalization (40.3% in 2002 to 5.3% in 2020), as well as mortality rate (0.9% in 2002 to 0.6% in 2020). Conclusion: Male gender and the age range of toddlers were the most affected group by poisoning. Non-pharmaceutical toxicity, especially illicit drugs and hydrocarbons were the most common cause of poisoning in our study. In contrast to hydrocarbons, pesticides, and pharmaceuticals, we found an increasing trend in opioid poisoning during the time period of our study.

Cannabis Edibles Are Increasingly Responsible for Pediatric Poison Center Calls

More states are legalizing cannabis, including edible products, but the impact on unintentional ingestions by children remains unknown. Researchers

Epidemiology in oral antidiabetic poisoning in children and adolescents – a four-year study in a pediatric poison centre

Oral antidiabetics have become a common etiology associated with acute poisoning in children. The study shall carry out an analysis of the demographic characteristics, circumstantial characteristics and clinical profile associated with oral antidiabetic poisoning. An observational, descriptive and retrospective study was carried out over a period of 4 years including children confirmed with the diagnosis of acute poisoning with oral antidiabetics. In the study group, there is a prevalence of voluntary acute poisoning in female patients in the 15 to 18 year age group. bIn the group study biguanides were the most frequent pharmaceutical dugs involved. The predominant clinical manifestations associated with oral antidiabetic intoxications were gastrointestinal.

Evaluation of Pediatric Patients Admitted to the Emergency Department Due to Drug Intoxication.

Introduction: Pediatric intoxication cases are one of the important emergency room admissions. Early diagnosis and treatment are important in reducing morbidity and mortality. The prevalence and exposure types of pediatric intoxications have social and regional differences. In this study, we aimed to retrospectively analyze the demographic and epidemiological characteristics, clinical course, and prognosis of patients admitted to our Emergency Medicine Clinic due to poisoning.Materials and Methods: In our study, the files of patients under 18 who were considered drug intoxicated and admitted to the ED were scanned retrospectively between 01.01.2018 and 31.12.2019. The cases were grouped as preschool (0-4 years old), school-age (4-12 years old), and adolescent (12-18 years old). The relationship between the frequency of emergency admissions of the patients, the variety of active ingredients, the amount taken, the need for hospitalization according to the active ingredients, admission times, arrival time to the emergency room, age, and gender were analyzed.Results: When the distributions by age groups are examined, most of the patients constitute the two-year-old (22%). Besides, it was found that among the age groups, there were more girls than boys in the 12-18 age group. A statistically significant difference was found between the frequency of active substance intake and gender differences according to age groups (p <0.001, p <0.001, respectively). However, no statistically significant relationship was found between age groups and seasonal admission frequencies (p = 0.055).Conclusions: Our study found a statistically significant difference in the amount of active substance taken or exposed to by age groups and gender. However, this finding does not explain the effect of active substance intake or exposure and gender on mortality and morbidity, probably due to the limited sample size.

Paediatric poisoning presentations reported to a regional toxicology service in Australia.

The aim of this study is to describe the epidemiology and health-care utilisation of paediatric emergency department (ED) presentations due to poisoning. A retrospective review of all ED presentations of paediatric poisoning cases (<18 years) reported to a tertiary toxicology service from 2015 to 2016 was conducted. Cases were classified into three age groups: pre-school (0-6 years), primary school (7-11 years) and adolescent (12-17 years). Outcomes included patient transfer, length of ED stay (LOS) and proportion admitted to a medical ward, mental health unit or intensive care unit (ICU). From 764 consultations over a 2-year period, 87 were excluded as non-ED presentations. From these, there were 194 (29%; 47% female) pre-school aged, 34 (5%; 41% female) primary school aged and 449 (66%; 77% female) adolescent presentations. Deliberate self-poisoning was most common in 394 of 449 (88%) adolescents. Accidental exposures accounted for 159 (82%) of pre-school presentations and natural toxins occurred in all three age groups. Paracetamol, selective serotonin reuptake inhibitors, antipsychotics and ibuprofen were the most common toxins. Discharge from ED occurred in 147 of 194 (76%) pre-school, 24 of 34 (71%) primary school and 223 of 449 (50%) adolescent presentations. Of the 449 adolescents, 137 (31%) were admitted medically (median LOS 19.9h), 19 were admitted to ICU (median LOS 71 h) and 70 (16%) admitted to mental health (median LOS 122 h). Five pre-school aged children were admitted to ICU. Adolescent deliberate self-poisoning has a significant impact on hospital resources, with mental health problems requiring extended length of stay. There were fewer pre-school accidental poisoning consultations, which were mainly discharged from ED.

Pediatric clonidine and guanfacine poisoning: a single-center retrospective review

Clonidine and guanfacine are centrally acting sympatholytics (CAS). Poisoning with these agents is common in children, and management of this poisoning is controversial. We sought to characterize our experience with pediatric CAS poisonings. We used an internal database to identify patients with CAS poisoning seen by the medical toxicology service at our children’s hospital from January 2001 through November 2019. We performed a retrospective chart review. We identified 56 patients with clonidine poisoning and 19 patients with guanfacine poisoning. Sixty-six percent of patients with clonidine poisoning underwent any medical intervention, as did 32% of patients with guanfacine poisoning. The most common interventions were fluids and naloxone. Endotracheal intubation was uncommon. The median hospital length of stay was one day and the median ICU length of stay was one day. Two patients died; one co-ingested a large amount of bupropion and one aspirated charcoal, leading to pneumonitis and anoxic brain injury. No patient with isolated CAS poisoning died. In this retrospective single-center review, pediatric patients tolerated CAS poisoning well. CAS poisoning did not directly result in death. Most pediatric patients with CAS poisoning had short hospital lengths of stay and did not undergo critical care interventions.

Toxicological exposures among the pediatric patients at a tertiary care center in Lebanon: the case for establishing a national poison center

Background Despite its preventable nature, poisoning remains one of the leading causes of morbidity and mortality in the pediatric population. In Lebanon, this population is poorly studied and there is no poison center to which healthcare providers and the public can refer in case of toxicological exposure, leading to unnecessary Emergency Department (ED) visits. This study describes the pediatric toxicological exposures seen at the largest tertiary care center in Lebanon. It also evaluates the appropriateness of ED visits among confirmed or suspected toxicological exposures in children, in order to assess the role of a national poison center in reducing unnecessary ED visits. Methods This is a secondary analysis of a database for a telephonic medical toxicology service at the American University of Beirut Medical Center, the largest tertiary care center in Lebanon. Data relating to all pediatric patients aged 0–19 years of age were entered into the database by the medical toxicology team. The cases were independently reviewed by 2 medical toxicologists for the adequacy of referral to the ED and performance of invasive procedures. Results Two hundred and nine exposures were recorded between 15 April 2015 and 31 December 2019, of which 53.1% were females. Children aged less than 5 years were involved in 67.0% of cases while adolescents aged 13–19 years were involved in 21.1%. The most commonly involved substances were analgesics (14.8%) and cardiovascular drugs (10.0%). The majority had no (59.3%) or minor (26.3%) effects and were treated and discharged home (67.5%). More than a third of ED visits were deemed unnecessary by the toxicologists (Kappa = 0.705), and when including only unintentional cases, around 45% of the ED visits were deemed unnecessary (Kappa = 0.677). Conclusion Our data show that 37% of all pediatric poisoning ED visits and 45% of ED visits due to unintentional pediatric poisonings were unnecessary. Additionally, more often than not lavage suctions were done unnecessarily. Future research investigating the possibility of preventing unnecessary visits by establishing a national poison center is needed.

Survey Extent Antibiotics and Others Pediatric-intoxication Affected Pediatric-public-health in Saudi-society

This paper was for "Survey extent antibiotics (As) and others pediatric-intoxication (PI) affected pediatric-public-health (PPH) in Saudi-society (SS)". That showed for age (0-2) year (yr) un-aware parents 70% for drugs-intoxication (DsI) symptoms. Parents 69% using colored and smelled attractive materials, drug 78.2% was used for kid without medical prescription (MP). For age (3-6) yr, 56.8% used Ds of non-MP. Parents 73.1% used their own medicines in front of their kids. In age (7-13) yr, PI showed 5%, it was by parents used same drug for kids represented 45.4%. It was 20.6% noticed new symptoms on their kids and did not go to pediatric Doctor Clinic. PI for age (0-2) yr was 4.3%, AsI was 16.7% that of DsI cases in SS. It was for age (3-6) yr with drugs and other equivalent 11.4%. AsI was 43.4% and non-DsI 57.7%, revealed 21.2% and non-AsI was 21.1%. PI for age (7-13) yr were 54.3% of cases of DsI. That 17.2% was of the AsI cases, One-third of the DsI were considered high, 37.1% non-DsI. That concluded the parents' awareness and education to improve PI reduction. As well they must do not leave different materials closely to kids, to make this difficult to obtain and difficult to use. They must teaching kids the seriousness effects of as and others on their health that will keep PPH in SS. Must recommended "Health Education" for parents to know PI dangerous, decrease PI through MP, consulting Pediatric Doctor, keep chemical materials and drugs away from kids.

The prevalence of liquid chromatography-tandem mass spectrometry confirmed paediatric poisoning at Red Cross War Memorial Children\u2019s Hospital, Cape Town, South Africa

BackgroundPaediatric poisoning is a common presentation to emergency departments worldwide. There is a paucity of data on the role of liquid chromatography-tandem mass spectrometry (LC-MS/MS), in the management of paediatric poisoning in low-and middle-income countries (LMICs). In high-income countries, most studies are retrospective, and few include children.ObjectiveThe study describes the prevalence of liquid chromatography-tandem mass spectrometry confirmed paediatric poisoning at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa.MethodsChildren admitted with suspected poisoning between 1 January 2017 and 31 December 2017, were recruited. All patients had a urine and/or blood sample sent for LC-MS/MS toxicology. Data collected included demographic data, clinical features, investigations, management, outcome and social interventions.ResultsOne hundred fifty-two children, with median age of 39 (IQR 25–61) months were enrolled of which 128 (84%) were poisoning cases. Of the 128 poisoning cases, 88 (69%) presented with a history of ingesting a known substance, 16 (12%) an unknown substance and 24 (19%) were cases of occult poisoning. LC-MS/MS was able to identify a substance in 92% of the cases of occult poisoning. In those who had presented with a seemingly known substance, LC-MS/MS found a different substance in 15 cases. LC-MS/MS was also able to detect multiple drugs in 40 patients. Of the poisoning cases, six (5%) cases were attempted homicide cases and 5 (4%) cases were attempted suicide cases. No children died. Individualized social interventions were instituted in poisoning cases. Emergency placement safety reasons was required in 6 children.ConclusionWhen the limitations are known, LC-MS/MS is useful in identifying cases of occult poisoning, identifying patients who have ingested multiple substances and/or an unknown substance and when targeted towards child protection. As LC-MS/MS is an expensive test, it should be used judiciously in LMICs.

Opioid exposures in children under 5 years of age (2004-2019): A retrospective study of calls to Australia's largest poisons information centre.

To describe time trends in opioid exposures in children under 5 years, and to describe patient demographics, the medicines involved, the reasons for exposure and disposition. A retrospective analysis of paediatric (<5 years of age) opioid exposure calls to the New South Wales Poisons Information Centre (NSWPIC, Australia's largest poison centre), 2004-2019. Joinpoint regression analysis was used to examine temporal trends. There were 4807 cases of paediatric opioid exposure during the 16 year study period, with an average of 300 exposures per year. Exposures increased, 2004-2007, with an annual percentage change (APC) of 14.6% (95% CI=4.3 to 26.0%), then decreased, 2007-2016, APC -3.4% (95% CI=-5.3 to -1.3%). A steeper decrease was observed after 2016, APC -14.1% (95% CI=-21.8 to -5.6%). The overall APC was -2.3% (95% CI=-4.7 to 0.2%), 2004-2019. Accidental exposures accounted for 86% of calls (4137). The majority of calls were from family members regarding exposures that happened at home, highlighting the need for safety initiatives. The preparations most frequently involved were paracetamol/opioid combination products (primarily codeine), 53% (2566) and ibuprofen/opioid combinations 14% (650). Twenty-two percent of cases were referred to a hospital (1062), and a further 15% (719) of calls originated from hospital staff. Opioid exposures in young Australian children continue to occur; however, the rate has declined since 2007. Safe storage and parent education initiatives could further reduce the burden of paediatric opioid poisoning in Australia.

Retrospective Study of Acute Pediatric Intoxication Cases by Household Products Presented to the Poison Control Center of Ain-Shams University Hospitals

Background: Acute poisoning in children is a crucial pediatric emergency and may be a worldwide problem.This study aims to acknowledge the incidence of acute poisoning by household products in children regardingdemographic factors, common clinical presentation and outcome of management.Methods: this is often a descriptive retrospective study conducted on patients admitted to the Poison ControlCentre of Ain-Shams University Hospital. The duration of the study was one year, from the beginning ofJanuary, 2016 till the top of December, 2016. the entire number of cases was 846 cases collected and analyzedregarding the demographic data, condition of poisoning, common clinical presentation, and managementplan. Data was analyzed using computer software package SPSS 15.Results: a complete of 846 cases were reviewed, the varied age groups involved ranged from but one year to18 years, with a mean age of 10.22 ± 6.83 years. Most cases were females (67 %), living in urban areas (52.4%) and therefore the majority of cases were accidental (74 %). the foremost common offending agent waspesticides (71%). Most of the patients were vitally stable on admission and therefore the commonest clinicalpresentation was gastrointestinal symptoms (31.3%). Most of cases received medical treatment within theinpatient wards (80.5%) and (96.7%) improved while (3.3 %) died.Conclusions: Acute poisoning by household products is common among adolescents and pre-school agechildren. Pesticides were liable for the bulk of cases. Supportive and symptomatic therapy is that the mainmethod for treatment.

Updates in teenage acute intentional self-poisonings

"Abstract: Acute intentional poisonings represent an important part of emergency pediatric pathology, as well as a psychiatric one, with an escalation tendency over the past years. The current paper consists of a descriptive prospective study, which took place over a period of 12 months, and included 342 children within the age range 6-18 years, that presented in the Emergency Unit, being subsequently treated as in-patients of the Pediatric Poisoning Center of “Grigore Alexandrescu” Emergency Clinical Hospital for Children. The number of pediatric acute intentional poisonings hospitalized within the time frame of the study was 819 cases. Of these, 342 were intentional, which constitutes a percentage of 41.75%, and 477 were accidental, i.e. 58.24%. The etiology of the acute intentional poisonings is varied; however, medication (54.38%), ethanol (28.65%) and drugs of abuse (12.28%) were predominant. A higher frequency of acute intentional poisonings was noticed in girls (65.49%) as compared to boys (34.50%), probably due to the particularities the psychological profile of this sex shown at this age, i.e. higher emotional instability and display tendency. Out of the total number of acute intentional poisonings, we identified 20 cases of suicide attempts, which represent 5.83% of the total acute voluntary poisonings. Moreover, some of these cases constitute a repeated suicide attempt. The studied group included 30 cases of chronic substance abuse and 6 chronic alcohol abuse cases, with ages within the 13-17 years range, 12 of which were females and 24 males. Out of the 36 chronic substance/alcohol abuse patients, 4 were social cases. Pediatric acute intentional self-poisonings are an important public health issue, alarming through its consequences and through its hidden neuropsychiatric and behavioral substrate. This is due to the fact that adolescence is a period of marked emotional fragility, sensitive to all sorts of influences. Keywords: self-poisoning, teenager, psychiatric disorders, alcohol, substances of abuse"

Economic burden of pediatric prescription opioid poisonings in the United States.

BACKGROUND: Among the different drugs involved in pediatric exposures and poisonings, opioids are the most important, given their rise in nonmedical use. Opioid poisonings in children can result in serious symptoms or complications, including respiratory disorders such as apnea, respiratory failure, and respiratory depression; psychiatric or nervous system disorders such as agitation, seizures, and coma; and cardiac disorders such as tachycardia, bradycardia, and cardiac arrest. Opioid poisonings in children can have delayed onset of symptoms as well as severe and prolonged toxic effects. Many studies have examined the economic burden of opioid poisoning in the general population, but very little is known about the pediatric population. OBJECTIVE: To estimate the economic burden associated with pediatric prescription opioid poisonings. METHODS: This study examined opioid poisonings in pediatric patients, defined as patients aged less than 18 years, for the 2012 base year. Costs were estimated using the 2012 Nationwide Emergency Department Sample (NEDS), Kids' Inpatient Database (KID), Multiple Cause-of-Death (MCOD) file, and other published sources, while applying a societal perspective. The Bottom Up approach was used to estimate the total cost of pediatric prescription opioid poisonings. Direct costs included costs associated with emergency department (ED) visits, hospitalizations, and ambulance transports. Indirect costs were estimated using the human capital method and included productivity costs due to caregivers' absenteeism and premature mortality among children. Descriptive statistics were employed in calculating costs. RESULTS: The total costs of pediatric prescription opioid poisonings and exposure in the United States were $230.8 million in 2012. Total direct costs were estimated to be over $21.1 million, the majority resulting from prescription opioid poisoning-related inpatient stays. Total indirect (productivity) costs were calculated at $209.7 million, and 98.6% of these costs were attributed to opioid poisoning-related mortality. Pediatric prescription opioid poisoning-related ED visits, inpatient stays, and deaths were most common in patients aged 13-17 years and those in mid to large urban areas. Most were unintentional. CONCLUSIONS: Pediatric prescription opioid poisonings resulted in direct and indirect costs of $230.8 million in 2012. While these costs are low in comparison with the costs of prescription opioid poisoning in the general population, the number of pediatric poisonings represents only a small fraction of total poisonings. Quantified costs associated with pediatric prescription opioid poisonings can help decision makers to understand the economic trade-offs in planning interventions. DISCLOSURES: This research had no external funding but was funded by an unrestricted research grant made to the Department of Pharmacotherapy & Outcomes Science by kaléo Pharma, maker of a naloxone product. The authors declare no conflicts of interest or financial interests. Portions of this study were presented as an abstract at the 22nd Annual ISPOR Meeting; May 22, 2017; Boston, MA.

Pediatric clonidine poisoning

Clonidine, a commonly used anti-hypertensive agent, is being increasingly used in the treatment of pediatric behavioral disorders, thus increasing the incidence of pediatric poisoning. Poisoning causes somnolence, respiratory depression, hypotension, sinus bradycardia, and miosis. Clonidine overdose of >0.01 mg/kg causes bradycardia and hypotension and >0.02 mg/kg causes apnea and respiratory depression. A 13-year-old boy presented to us with ingestion of 0.073 mg/kg clonidine. He had only sinus bradycardia and drowsiness, which had resolved without any active interventions. As the life-threatening side effects of clonidine poisoning seem to be very rare even at toxic doses, it can be used safely in the pediatric age group.