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Poisoning in children 1: General management
  1. M Riordan1,
  2. G Rylance2,
  3. K Berry3
  1. 1Department of Pediatrics, Yale University Medical School, USA
  2. 2Department of General Paediatrics, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  3. 3Accident and Emergency Department, Birmingham Children’s Hospital, Birmingham, UK
  1. Correspondence to:
    Dr K Berry, Accident and Emergency Department, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK;

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Basic principles in the management of poisoning

In this, the first of a series of five articles, we deal with basic principles in the management of poisoning in children.

A working knowledge of the management of poisoning in children is essential for all those involved in acute paediatric care. An estimated 52 000 people attended accident and emergency departments with poisoning in 1997, the majority of whom were children.1 Table 1 shows the commonest agents involved.

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Table 1

Common agents involved in poisoning1


Wherever possible the constituents of the substance ingested and its dosage per kilo body weight should be identified as accurately as possible.

In younger children the substance taken is often easily identifiable but the dosage can be difficult to ascertain. Some idea of the maximum amount of substance that could have been ingested can be gathered from comparing the number of tablets, or volume of liquid remaining, with details on packaging.

Care must be taken not to overlook the involvement of other children in a poisoning incident.2 When children share a poisonous substance, it must be assumed that each child has taken the maximum amount.

In older children, a clear history of ingestion may not be forthcoming and illicit drugs are more likely to be involved. Specific enquiry should be made into the medicines prescribed to each member of the household, both currently and in the past.


In cases where poisoning is suspected, but cannot be confirmed by clinical history, a detailed physical examination, including a full neurological assessment, is an essential part of substance identification. Table 2 shows collections of signs and their possible causes.

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Table 2

Recognisable poison syndromes

A number of toxins acting on the autonomic nervous system can produce a mixed clinical picture because of effects on both muscarinic and nicotinic receptors.

In most …

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