Ingestions

Evaluation of the poisoned patient Acute pediatric poisonings generally present in preschool-age children or in adolescents. Children under five typically ingest a household product or pharmaceutical accidentally, while adolescents may ingest medications or illicit substances recreationally or in the context of a suicide attempt. Clinical presentation Young children often present to the emergency department without symptoms, so it is important to differentiate exposures (e.g. found in an area with pills available) from actual ingestions. Ingestions in this age group usually involve a single medication or household product. Toddlers often taste objects that appear attractive and may share them with a younger companion. Many medications are remarkably similar in color, size, and shape to candy. With liquids, parents may report children taking a single or multiple swallows of a substance before spitting it out. Estimate the volume of a swallow to be approximately 0.25 ml/kg. Occasionally, previously well children may present with an acute change in mental status or a clinical decompensation. A high level of suspicion is required to discover and manage a surreptitious ingestion in these cases. Adolescent ingestions are generally non-accidental. The ingestions may be impulsive whether stemming from recreational use or psychiatric disorders (mood disorders, schizophrenia, substance abuse), and the history may be unclear at the time of presentation. These ingestions often involve multiple medications, illicit drugs, and alcohol, and frequently result in symptoms. It is also important to consider that the patient may be despondent over an unwanted pregnancy or attempting to self-induce an abortion.