Fábio Bucaretchi1, Emílio C E Baracat. 1. Departamento de Pediatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP. bucaret@fcm.unicamp.br
Abstract
OBJECTIVE: To review the literature on acute toxic exposure in children, excluding envenomations. SOURCES OF DATA: MEDLINE review (emphasis on the past decade), including the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists position statements and position papers (peer-reviewed information based on scientific evidence and broad consensus) on gastrointestinal decontamination, multiple-dose activated charcoal and urine alkalinization. SUMMARY OF THE FINDINGS: Acute toxic exposure in children is a common event, mainly in children under six years of age. Death is rare. Although widely employed, there is no evidence that gastrointestinal decontamination and multiple-dose activated charcoal improve the outcome of poisoned patients. Very few efficient antidotes are used on a consistent basis, and some of them are very expensive and not available in Brazil. CONCLUSIONS: Ipecac syrup and cathartics should not be administered on a routine basis in acute toxic exposures in outpatient treatment. Excluding the contraindications, single-dose activated charcoal and gastric lavage may be considered within one hour of ingestion if a patient ingested a potentially toxic amount or a potentially lethal amount, respectively. Whole bowel irrigation, multiple-dose activated charcoal and urine alkalinization may be considered in a few situations. Fomepizole and octreotide are safe and efficient antidotes, which can be used in the treatment of alcohol (methanol and ethylene glycol) and sulfonylureas poisoning, respectively.
OBJECTIVE: To review the literature on acute toxic exposure in children, excluding envenomations. SOURCES OF DATA: MEDLINE review (emphasis on the past decade), including the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists position statements and position papers (peer-reviewed information based on scientific evidence and broad consensus) on gastrointestinal decontamination, multiple-dose activated charcoal and urine alkalinization. SUMMARY OF THE FINDINGS: Acute toxic exposure in children is a common event, mainly in children under six years of age. Death is rare. Although widely employed, there is no evidence that gastrointestinal decontamination and multiple-dose activated charcoal improve the outcome of poisoned patients. Very few efficient antidotes are used on a consistent basis, and some of them are very expensive and not available in Brazil. CONCLUSIONS:Ipecac syrup and cathartics should not be administered on a routine basis in acute toxic exposures in outpatient treatment. Excluding the contraindications, single-dose activated charcoal and gastric lavage may be considered within one hour of ingestion if a patient ingested a potentially toxic amount or a potentially lethal amount, respectively. Whole bowel irrigation, multiple-dose activated charcoal and urine alkalinization may be considered in a few situations. Fomepizole and octreotide are safe and efficient antidotes, which can be used in the treatment of alcohol (methanol and ethylene glycol) and sulfonylureas poisoning, respectively.