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Poisoning in children 3: Common medicines
  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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A wide variety of medicines are ingested by children

In this, the third of a series of articles on the management of poisoning, we deal with medicines commonly ingested by children.


Proprietary preparations for the treatment of coughs, colds, and nasal congestion are frequently ingested accidentally. Most preparations (75%) are made up of more than one active ingredient.

Sympathomimetic agents make up the largest group of ingredients. Their effects in overdose vary widely between agents. Individual susceptibility is also variable. Adverse effects are unusual and occur fairly soon after ingestion. Severe cases are associated with hypertension, reflex bradycardia, arrhythmias, convulsions, and coma. Treatment is supportive.

Paracetamol and aspirin make up the second biggest group of ingredients. Their presence should not be overlooked as measurement of blood concentration may be required, depending on the dose consumed.

Opioid analgesics are found in a number of preparations. Dextromethorphan is most frequently encountered. It has a low toxic potential and only produces side effects when ingested in considerable quantity. Codeine is also found in a number of preparations. It is more toxic in overdose.

Expectorants make up the final group of ingredients. These are mucosal irritants or stimulants. Their putative mechanism of action is to increase respiratory tract fluid, thereby facilitating its expulsion. Expectorants include guaiphenesin, ipecacuanha, ammonium salts, cineole, creosote, squill, and tolu. These agents may act as emetics in overdosage but because of their low dosage, toxicity is generally overshadowed by other ingredients.

The presence of several active ingredients in a single preparation may produce a confusing clinical picture and potentiate adverse effects. Poison centre advice should be sought if the maximum daily therapeutic dose of any preparation is exceeded.


Accidental ingestion of oral contraceptive pills rarely produces any toxic effect other than transient gastrointestinal upset on the following day. Parents should …

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