Poisoning

86 Poisoning

Overview/pathophysiology

Poisoning can result in death and is a leading cause of hospital visits for children. Every day in the United States, 374 children from birth to 19 yr of age are treated in emergency departments and 2 children die due to poisoning (CDC/Safe Kids, 2009). Poisoning may occur through ingestion, inhalation, or contact with skin or mucous membranes and is seen most often in children younger than 5 yr with the greatest incidence in children younger than 3 yr. Curiosity and natural desire to put things in their mouths put younger children at greater risk for accidental poisoning. Over 4 million calls were answered by U.S. poison centers in 2008. Children younger than 3 yr were involved in 38.7% of the poison exposures while 50% of all exposures were in children younger than 6 yr. Despite this, only 2% of the fatalities in 2008 were in children younger than 6 yr. The most common poisons in children 5 yr or younger include cosmetics/personal care items such as perfume or soap (13.5%), analgesics such as acetaminophen or ibuprofen (9.7%), household cleaning agents such as laundry detergent or floor cleaners (9.7%), foreign bodies/toys/miscellaneous such as the silica gel packages that remove moisture from packages and glow products (7.5%), and topical preparations such as diaper rash products and acne preparations (6.9%) (2008 Annual Report of American Association of Poison Control Centers’ National Poison Data System Report, 2009). Schillie et al. in 2009 estimated that 71,224 emergency department visits each year are made by children younger than 18 yr due to medication overdoses. Most of these unintentional overdoses are from prescription medications with 80% from unsupervised ingestions (children getting medications on their own). Inhalation of carbon monoxide is a common wintertime occurrence. Adolescents also have an increased incidence of hospitalization resulting from poisoning, but it is most often intentional and frequently involves inhaling substances (e.g., glues/adhesives, nail polish remover, paint thinner, air conditioning coolant) or ingesting alcohol or drugs (e.g., marijuana or “ecstasy”).

About 90% of all poisoning incidents occur in the home per the 2008 Poison Control Center data. Most homes have more than 500 toxic substances in them, and one third of these are in the kitchen. The garage is also particularly dangerous for children, with gasoline and pesticides among the toxic substances housed there. Improper storage of toxic substances and caregiver distraction are major factors of poisoning in children.