J Pediatr Intensive Care 2015; 04(02): 103-110
DOI: 10.1055/s-0035-1556753
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Pediatric Toxicology: Emerging Trends

Maureen A. Madden
1   Division of Critical Care Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
› Author Affiliations
Further Information

Publication History

08 November 2014

23 November 2014

Publication Date:
28 August 2015 (online)

Abstract

Poisoning represents one of the most common medical emergencies encountered worldwide and is especially problematic for children, who constitute the population that is most vulnerable and at risk for unintentional and preventable poisonings. The scope of toxic substances involved in poisoning is very broad, requiring health care providers to have an extensive knowledge of signs and symptoms of poisoning, as well as specific therapeutic interventions and antidotes. New synthetic and herbal substances have emerged that have resulted in significant poisoning morbidity and mortality in the pediatric population.

 
  • References

  • 1 World Health Organization. World Report on Childhood Injury Prevention, 2008. Available at: http://www.who.int/violence_injury_prevention/child/en/ . Accessed September 6, 2014
  • 2 Mowry JB, Spyker DA, Cantilena Jr LR, Bailey JE, Ford M. 2012 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 30th Annual Report. Clin Toxicol (Phila) 2013; 51 (10) 949-1229
  • 3 Spiller HA, Beuhler MC, Ryan ML, Borys DJ, Aleguas A, Bosse GM. Evaluation of changes in poisoning in young children: 2000 to 2010. Pediatr Emerg Care 2013; 29 (5) 635-640
  • 4 Bond GR, Woodward RW, Ho M. The growing impact of pediatric pharmaceutical poisoning. J Pediatr 2012; 160 (2) 265-270.e1
  • 5 Burghardt LC, Ayers JW, Brownstein JS, Bronstein AC, Ewald MB, Bourgeois FT. Adult prescription drug use and pediatric medication exposures and poisonings. Pediatrics 2013; 132 (1) 18-27
  • 6 Franklin RL, Rodgers GB. Unintentional child poisonings treated in United States hospital emergency departments: national estimates of incident cases, population-based poisoning rates, and product involvement. Pediatrics 2008; 122 (6) 1244-1251
  • 7 Ozanne-Smith J, Day L, Parsons B, Tibballs J, Dobbin M. Childhood poisoning: access and prevention. J Paediatr Child Health 2001; 37 (3) 262-265
  • 8 Calello DP, Henretig FM. Pediatric toxicology: specialized approach to the poisoned child. Emerg Med Clin North Am 2014; 32 (1) 29-52
  • 9 Sachdeva DK, Stadnyk JM. Are one or two dangerous? Opioid exposure in toddlers. J Emerg Med 2005; 29 (1) 77-84
  • 10 Liebelt EL, Shannon MW. Small doses, big problems: a selected review of highly toxic common medications. Pediatr Emerg Care 1993; 9 (5) 292-297
  • 11 Michael JB, Sztajnkrycer MD. Deadly pediatric poisons: nine common agents that kill at low doses. Emerg Med Clin North Am 2004; 22 (4) 1019-1050
  • 12 Hoffman RJ, Osterhoudt KC. Evaluation and management of pediatric poisonings. Pediatr Case Rev 2002; 2 (1) 51-63
  • 13 Funk RS, Brown JT, Abdel-Rahman SM. Pediatric pharmacokinetics: human development and drug disposition. Pediatr Clin North Am 2012; 59 (5) 1001-1016
  • 14 Henretig FM. Special considerations in the poisoned pediatric patient. Emerg Med Clin North Am 1994; 12 (2) 549-567
  • 15 Madden MA. Pediatric poisonings: recognition, assessment, and management. Crit Care Nurs Clin North Am 2005; 17 (4) 395-404 , xi
  • 16 Bryant S, Singer J. Management of toxic exposure in children. Emerg Med Clin North Am 2003; 21 (1) 101-119
  • 17 McFee RB, Caraccio TR. “Hang Up Your Pocketbook” — an easy intervention for the granny syndrome: grandparents as a risk factor in unintentional pediatric exposures to pharmaceuticals. J Am Osteopath Assoc 2006; 106 (7) 405-411
  • 18 Russo M, Pecker L, Wood J , et al. Grandparent involvement in exploratory pediatric poisonings: a hospital-based study. Clin Toxicol 2013; 51 (7) 592 (abstract)
  • 19 Rosenbaum CD, Carreiro SP, Babu KM. Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J Med Toxicol 2012; 8 (1) 15-32
  • 20 Prosser JM, Nelson LS. The toxicology of bath salts: a review of synthetic cathinones. J Med Toxicol 2012; 8 (1) 33-42
  • 21 Fass JA, Fass AD, Garcia AS. Synthetic cathinones (bath salts): legal status and patterns of abuse. Ann Pharmacother 2012; 46 (3) 436-441
  • 22 Woo TM, Hanley JR. “How high do they look?”: identification and treatment of common ingestions in adolescents. J Pediatr Health Care 2013; 27 (2) 135-144
  • 23 Rollins B, Keleher M. Emerging drug trends, 2012. Available at: http://www.lawofficer.com/article/investigation/emerging-drug-trends . Accessed November 2, 2014
  • 24 Grant-Alfieri A, Schaechter J, Lipshultz SE. Ingesting and aspirating dry cinnamon by children and adolescents: the “cinnamon challenge”. Pediatrics 2013; 131 (5) 833-835
  • 25 Shah AM, Calello DP, Quintero-Solivan J, Osterhoudt KC. The not-so-nice spice: a teenage girl with palpitations and dry mouth. Pediatr Emerg Care 2011; 27 (12) 1205-1207
  • 26 Lovett E, McNiff E. 5 shocking ways your kids try to get drunk, 2012. Available at: http://abcnews.go.com/Health/shocking-ways-kids-drunk/story%3Fid%3D17281602 . Accessed November 2, 2014
  • 27 Sifferlin A . Smoking alcohol: The dangerous way people are getting drunk, 2013 . Available at: http://healthland.time.com/2013/06/05/smoking-alcohol-the-dangerous-way-people-are-getting-drunk . Accessed November 2, 2014
  • 28 Wolk BJ, Ganetsky M, Babu KM. Toxicity of energy drinks. Curr Opin Pediatr 2012; 24 (2) 243-251
  • 29 O'Brien MC, McCoy TP, Rhodes SD, Wagoner A, Wolfson M. Caffeinated cocktails: energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Acad Emerg Med 2008; 15 (5) 453-460
  • 30 Seifert SM, Schaechter JL, Hershorin ER, Lipshultz SE. Health effects of energy drinks on children, adolescents, and young adults. Pediatrics 2011; 127 (3) 511-528
  • 31 Howland J, Rohsenow DJ. Risks of energy drinks mixed with alcohol. JAMA 2013; 309 (3) 245-246
  • 32 Hwang CF, Foot CL, Eddie G, Johnson L, Reith DM. The utility of the history and clinical signs of poisoning in childhood: a prospective study. Ther Drug Monit 2003; 25 (6) 728-734
  • 33 Holstege CP, Borek HA. Toxidromes. Crit Care Clin 2012; 28 (4) 479-498
  • 34 Nelson LS, Lewin NA, Howland MA, Hoffman R, Goldfrank L, Flomenbaum N. Initial evaluation of the patient: vital signs and toxic syndromes. In: Nelson LS, Lewin NA, Howland MA, Hoffman R, Goldfrank L, Flomenbaum N, , eds. Goldfrank's Toxicologic Emergencies. 9th ed. New York: McGraw-Hill; 2011: 33-36
  • 35 Hoffman RJ, Nelson L. Rational use of toxicology testing in children. Curr Opin Pediatr 2001; 13 (2) 183-188
  • 36 Liebelt E. Pediatric poisonings in the new millennium: new poisons, new insights, new evidence. Curr Opin Pediatr 2001; 13 (2) 155-156
  • 37 Liebelt EL. Old antidotes, new antidotes, and a ‘universal antidote’: what should we be using for pediatric poisoning?. Curr Opin Pediatr 2007; 19 (2) 199-200