Pattern of Acute Toxicity In Children Admitted To Poison Control Center, Ain Shams University Hospitals During The Year 2012 A Retrospective Study

Abstract

• The admitted children with acute poisoning represented 22% of the total pediatric cases presented to the PCC during the study period. • Adolescents represented the majority of the admitted cases, followed by toddlers while the least frequent age group was school age children (6-12 years). • Female gender was predominant in the adolescents and school age groups while male gender was predominant in younger age groups. • Unintentional poisonings occurred in all age groups while intentional poisoning occurred exclusively in older age groups (adolescents and school age groups).

• Intentional poisoning (mainly suicidal) was the most frequent manner of exposure in adolescents. • Drugs were more frequent cause of poisoning than non-medicinal products. Theophylline was the most frequent drug causing pediatric poisoning in the included cases.

• Pesticides were the most frequent non-medicinal agent causing acute poisoning in all age groups except for toddler age group where chemicals (kerosene and corrosives) were the most frequent agent. • The house was the site of exposure to poisons in all cases. • Winter was the season of greatest frequency of poisoning by pesticides, gases and drugs while the summer was the season of greatest frequency of animal, food, fish and plant poisoning; as well as chemicals poisoning. • Delay time was significantly increased in non- survivors in comparison with survivors. However, there was none significant correlation between delay time and severity of poisoning. • Ingestion was the most common route of exposure to poisons in all age groups

• The greatest frequency of cases presented with co-ingestion of other substances was found in the adolescents, followed by the toddlers.

• A small proportion of cases received pre-consultation treatment. Specific treatment (mainly atropine injection) was the most frequent pre-consultation treatment received by the cases, followed by decontamination procedures.

• Faulty management in the form of induction of emesis by salty water intake was found in 2.6% of the cases.

• Most cases presented with normal vital signs. The most frequent abnormalities were tachycardia, hypotension, tachypnea and hypothermia.

• Gastrointestinal manifestations (mainly nausea and vomiting) were the most frequent manifestations in the cases, followed by neurological manifestations.

• The most frequent cause of hypoglycemia in the included cases was pesticides, followed by hypoglycemic agents and corrosives. • Hypokalemia was found in 45.8% of the cases. Pesticides, followed by theophylline, were the most frequent cause in cases with hypokalemia, • Metabolic acidosis was the most frequent acid base disturbance that was most commonly caused by pesticides, followed by theophylline and opioids. • Theophylline was the most frequent cause of respiratory alkalosis, followed by pesticides. • Tramadol was the most frequent cause of respiratory acidosis, followed by pesticides. • Most of the cases required hospitalization for short periods (less than 24 hours). Pesticides, followed by corrosive substances were the most common cause in cases required prolonged hospital stay. • Pesticides were the most frequent poisonous agent in cases needed mechanical ventilation, followed by substances of abuse and poisonous gases. • All cases received supportive treatments while specific treatments were indicated in 22% of the cases. Atropine was the most frequent indicated antidote.