© 2002 Archives of Disease in Childhood
LEADING ARTICLE
Poisoning
Poisoning in children 5: Rare and dangerous poisons
1 Department of Pediatrics, Yale University Medical School, USA
2 Department of General Paediatrics, Royal Victoria Infirmary, Newcastle upon Tyne, UK
3 Accident and Emergency Department, Birmingham Children’s Hospital, Birmingham, UK
Correspondence to:
Correspondence to:
Dr K Berry, Accident and Emergency Department, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK;
kathleen.berry@bhamchildrens.wmids.nhs.uk
Management of children who have ingested ß blockers, digoxin, oral hypoglycaemics, organophosphates, carbon monoxide, cyanide, isopropanol, ethylene glycol, methanol, Ecstasy, LSD, cocaine, nicotine, and isoniazid
Keywords: poisoning
| The first 150 words of the full text of this article appear below. |
In the final paper in this series of articles on the management of poisoning, we deal with exposures to a variety of rare, but potentially very dangerous, toxins.
ß Blockers competitively antagonise the binding of catecholamines to ß receptors. The effect of specific agents in overdose depends on their receptor specificity, lipid solubility, partial agonist activity, and dose.
Bradycardia and hypotension are the commonest signs of cardiovascular toxicity, but tachycardia and hypertension can occur if a partial agonist is consumed. Other signs of cardiovascular toxicity include varying degrees of heart block, shock, and pulmonary oedema. Central effects can occur, particularly with propanolol, and include lethargy, hallucinations, and convulsions. Hypoglycaemia can also occur.
Asymptomatic children should receive activated charcoal. A period of 12 hours observation is advisable.1 Symptomatic children require intensive monitoring. Hypotension may respond to intravenous fluids. In resistant cases, intravenous glucagon (50–150 µg/kg in 5% dextrose) is the
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